title: The effectiveness of inodilators in reducing short term mortality among patient with severe cardiogenic shock: a propensity-based analysis.
abstract: BACKGROUND
  The best catecholamine regimen for cardiogenic shock has been poorly evaluated. When a vasopressor is required to treat patients with the most severe form of cardiogenic shock, whether inodilators should be added or whether inopressors can be used alone has not been established. The purpose of this study was to compare the impact of these two strategies on short-term mortality in patients with severe cardiogenic shocks.
  
  
  RESULTS
  Three observational cohorts of patients with decompensated heart failure were pooled to comprise a total of 1,272 patients with cardiogenic shocks. Of these 1,272 patients, 988 were considered to be severe because they required a vasopressor during the first 24 hours. We developed a propensity-score (PS) model to predict the individual probability of receiving one of the two regimens (inopressors alone or a combination) conditionally on baseline-measured covariates. The benefit of the treatment regimen on the mortality rate was estimated by fitting a weighted Cox regression model. A total of 643 patients (65.1%) died within the first 30 days (inopressors alone: 293 (72.0%); inopressors and inodilators: 350 (60.0%)). After PS weighting, we observed that the use of an inopressor plus an inodilator was associated with an improved short-term mortality (HR: 0.66 [0.55-0.80]) compared to inopressors alone.
  
  
  CONCLUSIONS
  In the most severe forms of cardiogenic shock where a vasopressor is immediately required, adding an inodilator may improve short-term mortality. This result should be confirmed in a randomized, controlled trial.
authors: Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris, France.
authors: Romain
authors: R
authors: Pirracchio
authors: Jiri
authors: J
authors: Parenica
authors: Matthieu
authors: M
authors: Resche Rigon
authors: Sylvie
authors: S
authors: Chevret
authors: Jindrich
authors: J
authors: Spinar
authors: Jiri
authors: J
authors: Jarkovsky
authors: Faiez
authors: F
authors: Zannad
authors: François
authors: F
authors: Alla
authors: Alexandre
authors: A
authors: Mebazaa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000401:mortality*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents
references: Crit Care Med. 2006 May;34(5):1456-63
references: 16557162
references: PLoS Med. 2007 Oct 16;4(10):e296
references: 17941714
references: Stat Med. 2009 Jul 10;28(15):1982-98
references: 19452569
references: Crit Care. 2009;13(2):R44
references: 19335912
references: Am Heart J. 2004 Jan;147(1):91-9
references: 14691425
references: Intensive Care Med. 2011 Feb;37(2):290-301
references: 21086112
references: Crit Care. 2011;15(6):R291
references: 22152228
references: Circulation. 2008 Feb 5;117(5):686-97
references: 18250279
references: Cardiovasc Res. 2002 Feb 1;53(2):392-404
references: 11827690
references: Eur J Heart Fail. 2003 Dec;5(6):741-9
references: 14675852
references: Transl Res. 2010 Nov;156(5):273-81
references: 20970750
references: Crit Care Med. 2011 Mar;39(3):450-5
references: 21037469
references: Circulation. 1990 Jan;81(1):1-13
references: 1967557
references: Stat Med. 2009 Nov 10;28(25):3083-107
references: 19757444
references: Crit Care Med. 2011 Mar;39(3):583-4
references: 21330855
references: Circulation. 2003 Jun 24;107(24):2998-3002
references: 12821585
references: JAMA. 2002 Mar 27;287(12):1541-7
references: 11911756
references: Eur Heart J. 2005 Feb;26(4):384-416
references: 15681577
references: Stat Med. 2011 Nov 30;30(27):3192-207
references: 21948462
references: Am Heart J. 2005 Feb;149(2):209-16
references: 15846257
references: Eur J Heart Fail. 2009 Apr;11(4):386-90
references: 19211570
references: Am J Cardiol. 2005 Sep 19;96(6A):47G-58G
references: 16181823
references: Crit Care Med. 2010 Jan;38(1):93-100
references: 19730258
references: Am Heart J. 1997 Dec;134(6):1089-98
references: 9424070
references: Eur J Heart Fail. 2006 Nov;8(7):697-705
references: 16516552
references: N Engl J Med. 2010 Mar 4;362(9):779-89
references: 20200382
references: Clin Res Cardiol. 2009 Aug;98(8):469-75
references: 19367424
references: Eur Heart J. 2012 Jul;33(14):1787-847
references: 22611136
references: Epidemiology. 2000 Sep;11(5):561-70
references: 10955409