Impact of inotropic therapy on mortality in cardiogenic shock following acute myocardial infarction

Abstract Introduction Cardiogenic shock (CS) complicates 3-13% of acute myocardial infarction (AMI) cases, with a mortality rate of approximately 40% within the first 30 days, making it the leading cause of death in AMI patients. AMI accounts for 81% of CS cases. Pharmacological therapies, including inotropic agents with vasoactive and vasopressor effects, are commonly administered in these cases. Purpose This study aimed to examine the relationship between inotropic therapy administered to patients with CS post-AMI and their mortality outcomes. Methods We conducted a prospective cross-sectional study from March 20 to October 20, 2024. Patients admitted with acute coronary syndrome (STEMI or NSTEMI) were evaluated, and those who developed CS were included in the study. Participants were categorized into two groups based on outcomes: a mortality group and a survival group. Results Among 1,166 patients admitted for acute coronary syndrome at the Clinic of Cardiology over the seven-month study period, 86 (7.4%) developed CS. Of these, 44 patients (51%) died. Table 1 compares the two groups with respect to the inotropic agents administered. Significant differences were observed in the number of inotropic agents used, with 52% of survivors receiving only one inotropic agent, compared to 20.5% in the mortality group (p=0.002). Additionally, patients who received noradrenaline more frequently and at higher doses were predominantly in the mortality group, as shown in Table 1. Variables with statistical significance were included in a multiple regression model (Table 2a), which showed statistical significance (p=0.02), indicating that patients receiving more than one inotropic agent, or noradrenaline at higher doses, were at a higher risk of mortality. Noradrenaline dose was identified as an independent predictor of mortality (Table 2b). Conclusions In our center, approximately 7% of patients with acute coronary syndrome develop CS, with nearly half resulting in death. Patients receiving a single inotropic agent have a higher survival chance, whereas those receiving noradrenaline, especially at higher doses, are at an elevated risk of mortality. This may reflect a trend of treating more critically ill patients with aggressive therapy or could indicate an effect of the treatment itself. Larger studies are needed to clarify this finding.