Milrinone no better than dobutamine for treatment of cardiogenic shock: NEJM
Canada: A recent study found no significant differences with respect to the primary composite outcome or important secondary outcomes in cardiogenic shock patients administered with milrinone versus dobutamine. The study findings appear in the New England Journal of Medicine.
The primary outcome was a composite of in-hospital death from any cause, nonfatal myocardial infarction, resuscitated cardiac arrest, transient ischemic attack or stroke diagnosed by a neurologist, or receipt of a cardiac transplant or mechanical circulatory support. Secondary outcomes included the individual components of the primary composite outcome.
"No-between group difference was observed in the primary composite outcome or in important secondary outcomes," wrote the authors.
Cardiogenic shock is associated with substantial mortality and morbidity. The mainstay of medical therapy for cardiogenic shock is inotropic support, however, in clinical practice, not much evidence exists to guide the selection of inotropic agents. Considering this, Rebecca Mathew, University of Ottawa, Ottawa, Canada, and colleagues randomly assigned patients with cardiogenic shock to receive milrinone or dobutamine in a double-blind fashion.
A total of 192 participants (96 in each group) were enrolled.
The researchers found the following:
- The treatment groups did not differ significantly with respect to the primary outcome; a primary outcome event occurred in 49% of participants in the milrinone group and 54% in the dobutamine group (relative risk, 0.90).
- There were also no significant differences between the groups with respect to secondary outcomes, including in-hospital death (37% and 43% of the participants, respectively; relative risk, 0.85), resuscitated cardiac arrest (7% and 9%; hazard ratio, 0.78), receipt of mechanical circulatory support (12% and 15%; hazard ratio, 0.78), or initiation of renal replacement therapy (22% and 17%; hazard ratio, 1.39).
"Our findings showed that in patients with cardiogenic shock, no significant difference between milrinone and dobutamine was found with respect to the primary composite outcome or important secondary outcomes," concluded the authors.
Reference:
The study titled, "Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock," is published in the New England Journal of Medicine.
DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2026845
