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Vasopressors for acute myocardial infarction complicated by cardiogenic shock

  • R. ProndzinskyEmail author
  • K. Hirsch
  • L. Wachsmuth
  • M. Buerke
  • S. Unverzagt
Originalien

Abstract

Several international evidence-based guidelines reveal the lack of evidence on the treatment of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) for all recommended therapies. We included 6 studies with 842 eligible patients and one ongoing study. Three different adrenergic agents (norepinephrine, dopamine, epinephrine), vasopressin and the NOS inhibitor tilarginine were compared in 4 different combinations. On the small basis of all available evidence we can state that there is no evidence to use tilarginene, some evidence to avoid dopamine due to increased rates of arrhythmias, but some evidence, which suggests to prefer norepinephrine in comparison to epinephrine as vasopressor.

Keywords

Acute coronary syndrome Cardiogenic shock Vasopressor agents Vasoconstriction Systematic review 

Vasopressoren bei infarktbedingtem kardiogenem Schock

Zusammenfassung

Verschiedene evidenzbasierte Leitlinien beklagen den Mangel an Evidenz bei der Behandlung von Patienten mit akutem infarktbedingtem kardiogenem Schock (iKS) bei allen empfohlenen Therapiemaßnahmen. Wir konnten 6 Studien (sowie eine laufende Studie) mit 842 geeigneten Patienten einschließen. Drei verschiedene adrenerge Substanzen (Adrenalin, Noradrenalin und Dopamin) sowie Vasopressin und der NOS-Inhibitor Tilarginin wurden in 4 verschiedenen Kombinationen verglichen. Aus der verfügbaren Evidenz kann keine Empfehlung für den Einsatz von Tilarginin, eine bedingte Empfehlung für die Vermeidung von Dopamin infolge vermehrter Arrhythmien sowie für den Einsatz von Noradrenalin im Vergleich zu Adrenalin als Vasopressor gegeben werden.

Schlüsselwörter

Akutes Koronarsyndrom Kardiogener Schock Vasopressoren Vasokonstriktion Systematische Übersicht 

Notes

Acknowledgements

We appreciate the support from the Cochrane Heart Group to create the search strategy.

We are grateful to members of the SHOCK-2 trial [65] and TRIUMPH trial [66]. Karen Pieper and Amanda Stebbins for providing individual patient data and additional information concerning these two trials. We are similarly grateful to Daniel De Backer who provided information and answered our questions concerning his study. We thank the members of the University Library in Munich for their support.

Funding

Internal sources. Wilhelm-Roux-Programme, Financial support (grant number 24/34)

External sources. Ministry for Education and Research, Germany, Financial support (grant number: 01KG1024)

This study was supported by a restricted grant from Biotronik Cooperation (Biotronik, Berlin, Germany). None of the authors has any affiliations with this company. Data analysis and interpretation was performed completely independent from this company.

Compliance with ethical guidelines

Conflict of interest

R. Prondzinsky, K. Hirsch, L. Wachsmuth, M. Buerke and S. Unverzagt declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

63_2017_378_MOESM1_ESM.pdf (265 kb)
Search Strategies
63_2017_378_MOESM2_ESM.pdf (302 kb)
Suppl. Tab. 1: Study characteristics
63_2017_378_MOESM3_ESM.pdf (202 kb)
Suppl. Fig. 2: Cardiac care with NOS inhibitors: short term mortality and subgroup analyses
63_2017_378_MOESM4_ESM.pdf (276 kb)
Suppl. Tab. 2: Adverse events
63_2017_378_MOESM5_ESM.pdf (268 kb)
Suppl. Tab. 3: Haemodynamics

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • R. Prondzinsky
    • 1
    Email author
  • K. Hirsch
    • 2
  • L. Wachsmuth
    • 1
  • M. Buerke
    • 3
  • S. Unverzagt
    • 2
  1. 1.Medizinische Klinik ICarl von Basedow-Klinikum Saalekreis gGmbHMerseburgGermany
  2. 2.Institut für Medizinische Epidemiologie, Biometrie und InformatikMartin Luther University Halle-WittenbergHalle/SaaleGermany
  3. 3.Klinik für Kardiologie, Angiologie und internistische IntensivmedizinMarienhospitalSiegenGermany

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