Vasopressors for acute myocardial infarction complicated by cardiogenic shock

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.

Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction

“…comparing the effects of vasopressor agents in patients with CS (5)(6)(7). In a randomized study comparing dopamine and norepinephrine (8), a subgroup analysis of 280 patients with CS found that dopamine was associated with increased 28-day mortality compared with norepinephrine, leading to a progressive decrease in dopamine use in this indication (9).…”