Key result
Early administration of β-blockers or RAAS blockers in ongoing cardiogenic shock was associated with higher 30-day mortality (27.3% vs 16.9%; adjusted HR 2.36; 95% CI 1.06-5.23; p=0.035).
Why the study?
Does early administration of β-blockers or renin-angiotensin-aldosterone system blockers affect 30-day mortality in patients with ongoing cardiogenic shock?
Cohort (n=240)
Yes
Does early administration of β-blockers or renin-angiotensin-aldosterone system blockers affect 30-day mortality in patients with ongoing cardiogenic shock?
Hazard Ratio: 2.36 (95% CI 1.06–5.23)
Absolute Event Rate: 27.3% vs 16.9%
p-value: p=0.035
Early administration of β-blockers or renin-angiotensin-aldosterone system blockers in patients with ongoing cardiogenic shock is associated with significantly higher 30-day mortality, primarily driven by β-blocker use.
May warrant caution with β-blockers/RAAS blockers in ongoing cardiogenic shock; leaves open optimal neurohormonal therapy in this population.
OBJECTIVES: Guidelines recommend β-blockers and renin-angiotensin-aldosterone system blockers to improve long-term survival in hemodynamically stable myocardial infarction patients with a reduced left ventricular ejection fraction. The prevalence and outcomes associated with β and renin-angiotensin-aldosterone system blocker therapy in patients with ongoing cardiogenic shock is unknown. DESIGN: Secondary analysis of a randomized controlled trial. SETTING: In patients with cardiogenic shock lasting more than 24 hours enrolled in Tilarginine Acetate Injection in a Randomized International Study in Unstable Myocardial Infarction Patients With Cardiogenic Shock, we compared 30-day mortality in patients who received β or renin-angiotensin-aldosterone system blockers (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or aldosterone antagonists) within 24 hours of randomization with those who did not. INTERVENTIONS: None. PATIENTS: The final study population included 240 patients. A total of 66 patients (27.5%) had either β blocker or renin-angiotensin-aldosterone system blocker administered within the first 24 hours after the diagnosis of cardiogenic shock. β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone antagonists were prescribed in 18.8%, 10.6%, and 5.0% of patients, respectively. MEASUREMENTS AND MAIN RESULTS: The observed 30-day mortality among patients was higher in patients who received β or renin-angiotensin-aldosterone system blockers prior to cardiogenic shock resolution (27.3% vs 16.9%; adjusted hazard ratio, 2.36; 95% CI, 1.06-5.23; p = 0.035). Compared with patients not given β or renin-angiotensin-aldosterone system blockers, the 30-day mortality was higher among patients treated only with β-blockers (33.3% vs 16.9%, p = 0.017) but not among those only treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (18.2% vs 16.9%, p = 1.000). CONCLUSIONS: The administration of β or renin-angiotensin-aldosterone system blockers is common in North America and Europe in patients with myocardial infarction and cardiogenic shock prior to cardiogenic shock resolution. This therapeutic practice was independently associated with higher 30-day mortality, although a statistically significant difference was only observed in the subgroup of patients administered β-blockers.
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Diepen et al. (2013) conducted a cohort in Myocardial infarction with ongoing cardiogenic shock (n=240). β-blockers or renin-angiotensin-aldosterone system blockers vs. No β-blockers or renin-angiotensin-aldosterone system blockers within 24 hours was evaluated on 30-day mortality (HR 2.36, 95% CI 1.06-5.23, p=0.035). Early administration of β-blockers or RAAS blockers in ongoing cardiogenic shock was associated with higher 30-day mortality (27.3% vs 16.9%; adjusted HR 2.36; 95% CI 1.06-5.23; p=0.035).
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