Meta-analysis of randomized trials of effect of milrinone on mortality in cardiac surgery: an update.
OBJECTIVE
The long-term use of milrinone is associated with increased mortality in chronic heart failure. A recent meta-analysis suggested that it might increase mortality in patients undergoing cardiac surgery. The authors conducted an updated meta-analysis of randomized trials in patients undergoing cardiac surgery to determine if milrinone impacted survival.


METHODS
A meta-analysis.


METHODS
Hospitals.


METHODS
One thousand thirty-seven patients from 20 randomized trials.


METHODS
None.


RESULTS
Biomed, Central, PubMed, EMBASE, the Cochrane central register of clinical trials, and conference proceedings were searched for randomized trials that compared milrinone versus placebo or any other control in adult and pediatric patients undergoing cardiac surgery. Authors of trials that did not include mortality data were contacted. Only trials for which mortality data were available were included. Overall analysis showed no difference in mortality between patients receiving milrinone versus control (12/554 [2.2%] in the milrinone group v 10/483 [2.1%] in the control arm; relative risk [RR] = 1.15; 95% confidence interval [CI], 0.55-2.43; p = 0.7) or in analysis restricted to adults (11/364 [3%] in the milrinone group v 9/371 [2.4%] in the control arm; RR = 1.17; 95% CI, 0.54-2.53; p = 0.7). Sensitivity analyses in trials with a low risk of bias showed a trend toward an increase in mortality with milrinone (8/153 [5.2%] in the milrinone arm v 2/152 [1.3%] in the control arm; RR = 2.71; 95% CI, 0.82-9; p for effect = 0.10).


CONCLUSIONS
Despite theoretic concerns for increased mortality with intravenous milrinone in patients undergoing cardiac surgery, the authors were unable to confirm an adverse effect on survival. However, sensitivity analysis of high-quality trials showed a trend toward increased mortality with milrinone.
Department of Medicine, University of California, San Francisco, CA, USA.
David T
DT
Majure
Teresa
T
Greco
Massimiliano
M
Greco
Martin
M
Ponschab
Giuseppe
G
Biondi-Zoccai
Alberto
A
Zangrillo
Giovanni
G
Landoni
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D006801:Humans; D020105:Milrinone / Q000008:administration & dosage / Q000627:therapeutic use*; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic
D002316:Cardiotonic Agents; D020105:Milrinone