title: Incidence and outcomes associated with early heart failure pharmacotherapy in patients with ongoing cardiogenic shock.
abstract: OBJECTIVE
  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 and outcomes associated with β and renin-angiotensin-aldosterone system blocker therapy in patients with ongoing cardiogenic shock is unknown.
  
  
  METHODS
  Secondary analysis of a randomized controlled trial.
  
  
  METHODS
  In patients with cardiogenic shock lasting more than 24 hours enrolled in Tilarginine Acetate Injection in a Randomized International Study in Unstable Myocardial Infarction Patients With Cardiogenic Shock, we compared 30-day mortality in patients who received β or renin-angiotensin-aldosterone system blockers (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or aldosterone antagonists) within 24 hours of randomization with those who did not.
  
  
  METHODS
  None.
  
  
  METHODS
  The final study population included 240 patients. A total of 66 patients (27.5%) had either β blocker or renin-angiotensin-aldosterone system blocker administered within the first 24 hours after the diagnosis of cardiogenic shock. β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone antagonists were prescribed in 18.8%, 10.6%, and 5.0% of patients, respectively.
  
  
  RESULTS
  The observed 30-day mortality among patients was higher in patients who received β or renin-angiotensin-aldosterone system blockers prior to cardiogenic shock resolution (27.3% vs 16.9%; adjusted hazard ratio, 2.36; 95% CI, 1.06-5.23; p = 0.035). Compared with patients not given β or renin-angiotensin-aldosterone system blockers, the 30-day mortality was higher among patients treated only with β-blockers (33.3% vs 16.9%, p = 0.017) but not among those only treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (18.2% vs 16.9%, p = 1.000).
  
  
  CONCLUSIONS
  The administration of β or renin-angiotensin-aldosterone system blockers is common in North America and Europe in patients with myocardial infarction and cardiogenic shock prior to cardiogenic shock resolution. This therapeutic practice was independently associated with higher 30-day mortality, although a statistically significant difference was only observed in the subgroup of patients administered β-blockers.
authors: 1Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, Alberta, Canada. 2Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY. 3Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. 4Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. 5Institute of Cardiology, Warsaw, Poland. 6Wilhelminen Hospital, Vienna, Austria. 7Third Faculty of Medicine, Charles University Prague, Czech Republic. 8Robert Wood Johnson Medical School and Cooper University Hospital, Camden, NJ. 9University of Vermont, Burlington, VT. 10Newark Beth Israel Medical Center, Newark, NJ.
authors: Sean
authors: S
authors: van Diepen
authors: Harmony R
authors: HR
authors: Reynolds
authors: Amanda
authors: A
authors: Stebbins
authors: Renato D
authors: RD
authors: Lopes
authors: Vladimír
authors: V
authors: Džavík
authors: Witold
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authors: Ruzyllo
authors: Alexander
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authors: Geppert
authors: Petr
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authors: Widimsky
authors: E Magnus
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authors: Ohman
authors: Joseph E
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authors: Parrillo
authors: Harold L
authors: HL
authors: Dauerman
authors: David A
authors: DA
authors: Baran
authors: Judith S
authors: JS
authors: Hochman
authors: John H
authors: JH
authors: Alexander
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012770:Shock, Cardiogenic / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome; D019323:omega-N-Methylarginine
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D001120:Arginine; D000451:Mineralocorticoid Receptor Antagonists; C092506:N(G)-monomethylarginine acetate; D019323:omega-N-Methylarginine