Incidence and Outcomes Associated With Early Heart Failure Pharmacotherapy in Patients With Ongoing Cardiogenic Shock

• DOI: 10.1097/ccm.0b013e31829f6242
• Publication Date: 2013-08-27T09:26:23Z
• Authors: Sean van Diepen; Harmony R. Reynolds; Amanda Stebbins; Renato D. Lopes; Vladimír Džavík; Witold Ruzyllo; Alexander Geppert; Petr Widimsky; E. Magnus Ohman; Joseph E. Parrillo; Harold L. Dauerman; David A. Baran; Judith S. Hochman; John H. Alexander
• Keywords: Heart Failure; Male; Time Factors; Incidence; Adrenergic beta-Antagonists; Shock, Cardiogenic; Middle Aged; Arginine; 3. Good health; Renin-Angiotensin System; Angiotensin Receptor Antagonists; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Double-Blind Method; Humans; Female; Aged; Mineralocorticoid Receptor Antagonists

Objectives: Guidelines recommend β-blockers and renin-angiotensin-aldosterone system blockers to improve long-term survival in hemodynamically stable myocardial infarction patients with a reduced left ventricular ejection fraction. The prevalence outcomes associated β blocker therapy ongoing cardiogenic shock is unknown. Design: Secondary analysis of randomized controlled trial. Setting: In lasting more than 24 hours enrolled Tilarginine Acetate Injection Randomized International Study Unstable Myocardial Infarction Patients With Cardiogenic Shock, we compared 30-day mortality who received or (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone antagonists) within randomization those did not. Interventions: None. Patients: final study population included 240 patients. A total 66 (27.5%) had either administered the first after diagnosis shock. β-blockers, angiotensin-converting inhibitors antagonists were prescribed 18.8%, 10.6%, 5.0% patients, respectively. Measurements Main Results: observed among was higher prior resolution (27.3% vs 16.9%; adjusted hazard ratio, 2.36; 95% CI, 1.06–5.23; p = 0.035). Compared not given treated only (33.3% 16.9%, 0.017) but (18.2% 1.000). Conclusions: administration common North America Europe resolution. This therapeutic practice independently mortality, although statistically significant difference subgroup β-blockers.