Impact of baseline beta-blocker use on inotrope response and clinical outcomes in cardiogenic shock: a subgroup analysis of the DOREMI trial.

Adrenergic beta-Antagonists / adverse effects Aged Aged, 80 and over Cardiotonic Agents / administration & dosage Dobutamine / adverse effects Dose-Response Relationship, Drug Double-Blind Method Female Humans Male Middle Aged Milrinone / adverse effects Mortality / trends Outcome Assessment, Health Care / methods Shock, Cardiogenic / drug therapy
Beta-blocker Cardiogenic shock Dobutamine Inotropes Milrinone

Journal

Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902

Informations de publication

Date de publication:
10 08 2021
Historique:
received: 29 10 2020
accepted: 19 02 2021
entrez: 11 8 2021
pubmed: 12 8 2021
medline: 21 10 2021
Statut: epublish

Résumé

Cardiogenic shock (CS) is associated with significant morbidity and mortality. The impact of beta-blocker (BB) use on patients who develop CS remains unknown. We sought to evaluate the clinical outcomes and hemodynamic response profiles in patients treated with BB in the 24 h prior to the development of CS. Patients with CS enrolled in the DObutamine compaREd to MIlrinone trial were analyzed. The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, need for cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite and hemodynamic response profiles derived from pulmonary artery catheters. Among 192 participants, 93 patients (48%) had received BB therapy. The primary outcome occurred in 47 patients (51%) in the BB group and in 52 (53%) in the no BB group (RR 0.96; 95% CI 0.73-1.27; P = 0.78) throughout the in-hospital period. There were fewer early deaths in the BB group (RR 0.41; 95% CI 0.18-0.95; P = 0.03). There were no differences in other individual components of the primary outcome or in hemodynamic response between the two groups throughout the remainder of the hospitalization. BB therapy in the 24 h preceding the development of CS did not negatively influence clinical outcomes or hemodynamic parameters. On the contrary, BB use was associated with fewer deaths in the early resuscitation period, suggesting a paradoxically protective effect in patients with CS. Trial registration ClinicalTrials.gov Identifier: NCT03207165.

Sections du résumé

BACKGROUND
Cardiogenic shock (CS) is associated with significant morbidity and mortality. The impact of beta-blocker (BB) use on patients who develop CS remains unknown. We sought to evaluate the clinical outcomes and hemodynamic response profiles in patients treated with BB in the 24 h prior to the development of CS.
METHODS
Patients with CS enrolled in the DObutamine compaREd to MIlrinone trial were analyzed. The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, need for cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite and hemodynamic response profiles derived from pulmonary artery catheters.
RESULTS
Among 192 participants, 93 patients (48%) had received BB therapy. The primary outcome occurred in 47 patients (51%) in the BB group and in 52 (53%) in the no BB group (RR 0.96; 95% CI 0.73-1.27; P = 0.78) throughout the in-hospital period. There were fewer early deaths in the BB group (RR 0.41; 95% CI 0.18-0.95; P = 0.03). There were no differences in other individual components of the primary outcome or in hemodynamic response between the two groups throughout the remainder of the hospitalization.
CONCLUSIONS
BB therapy in the 24 h preceding the development of CS did not negatively influence clinical outcomes or hemodynamic parameters. On the contrary, BB use was associated with fewer deaths in the early resuscitation period, suggesting a paradoxically protective effect in patients with CS. Trial registration ClinicalTrials.gov Identifier: NCT03207165.

Identifiants

DOI: 10.1186/s13054-021-03706-2 PMID: 34376218 PMC: PMC8356445
pubmed: 34376218
doi: 10.1186/s13054-021-03706-2
pii: 10.1186/s13054-021-03706-2
pmc: PMC8356445
doi:

Substances chimiques

Adrenergic beta-Antagonists 0
Cardiotonic Agents 0
Dobutamine 3S12J47372
Milrinone JU9YAX04C7

Banques de données

ClinicalTrials.gov
['NCT03207165']

Types de publication

Journal Article Randomized Controlled Trial

Langues

eng

Sous-ensembles de citation

IM

Pagination

289

Informations de copyright

© 2021. The Author(s).

Références

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Auteurs

Pietro Di Santo (P)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

Rebecca Mathew (R)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

Richard G Jung (RG)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.

Trevor Simard (T)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.

Stephanie Skanes (S)

Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Brennan Mao (B)

Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

F Daniel Ramirez (FD)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France.
LIRYC (L'Institut de Rythmologie Et Modélisation Cardiaque), Bordeaux-Pessac, France.

Jeffrey A Marbach (JA)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Division of Critical Care, Tufts Medical Center, Boston, MA, USA.

Omar Abdel-Razek (O)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Pouya Motazedian (P)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Department of Medicine, Cumming School of Medicine, Calgary, AB, Canada.

Simon Parlow (S)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Kevin E Boczar (KE)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

Gianni D'Egidio (G)

Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

Steven Hawken (S)

Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Jordan Bernick (J)

Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada.

George A Wells (GA)

Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada.

Alexander Dick (A)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Derek Y So (DY)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Christopher Glover (C)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Juan J Russo (JJ)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Caroline McGuinty (C)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Benjamin Hibbert (B)

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, H-4238, Ottawa, ON, K1Y 4W7, Canada. bhibbert@ottawaheart.ca.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. bhibbert@ottawaheart.ca.
Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada. bhibbert@ottawaheart.ca.
ORCID: 0000-0003-0906-1363

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