Concomitant renal dysfunction mitigates clinical benefit of milrinone in cardiogenic shock patients: JACC study
figure 1. illustration of present study
Cardiogenic shock is associated with poor clinical outcomes. There is a paucity of prospective data examining the efficacy and safety of different inotropic agents in patients with cardiogenic shock and renal dysfunction. Although, the DOREMI trial demonstrated no difference between the two inotropic agents dobutamine and milrinone, but a recently conducted post hoc analysis of this trial shows that a potential clinical benefit of milrinone vs dobutamine in cardiogenic shock could be attenuated by development of AKI (acute kidney injury).
The authors stratified the DOREMI trial population based on both baseline renal dysfunction and the development of AKI and examined clinical outcomes with milrinone compared to dobutamine after stratification based on baseline estimated glomerular filtration rate (eGFR) 60 ml/min/1.73 m2and AKI.
The primary outcome was the composite of in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy.
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