Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest

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Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest. / Ameloot, Koen; Jakkula, Pekka; Hästbacka, Johanna; Reinikainen, Matti; Pettilä, Ville; Loisa, Pekka; Tiainen, Marjaana; Bendel, Stepani; Birkelund, Thomas; Belmans, Ann; Palmers, Pieter Jan; Bogaerts, Eline; Lemmens, Robin; De Deyne, Cathy; Ferdinande, Bert; Dupont, Matthias; Janssens, Stefan; Dens, Joseph; Skrifvars, Markus B.

I: Journal of the American College of Cardiology, Bind 76, Nr. 7, 18.08.2020, s. 812-824.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

Harvard

Ameloot, K, Jakkula, P, Hästbacka, J, Reinikainen, M, Pettilä, V, Loisa, P, Tiainen, M, Bendel, S, Birkelund, T, Belmans, A, Palmers, PJ, Bogaerts, E, Lemmens, R, De Deyne, C, Ferdinande, B, Dupont, M, Janssens, S, Dens, J & Skrifvars, MB 2020, 'Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest', Journal of the American College of Cardiology, bind 76, nr. 7, s. 812-824. https://doi.org/10.1016/j.jacc.2020.06.043

APA

Ameloot, K., Jakkula, P., Hästbacka, J., Reinikainen, M., Pettilä, V., Loisa, P., Tiainen, M., Bendel, S., Birkelund, T., Belmans, A., Palmers, P. J., Bogaerts, E., Lemmens, R., De Deyne, C., Ferdinande, B., Dupont, M., Janssens, S., Dens, J., & Skrifvars, M. B. (2020). Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest. Journal of the American College of Cardiology, 76(7), 812-824. https://doi.org/10.1016/j.jacc.2020.06.043

CBE

Ameloot K, Jakkula P, Hästbacka J, Reinikainen M, Pettilä V, Loisa P, Tiainen M, Bendel S, Birkelund T, Belmans A, Palmers PJ, Bogaerts E, Lemmens R, De Deyne C, Ferdinande B, Dupont M, Janssens S, Dens J, Skrifvars MB. 2020. Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest. Journal of the American College of Cardiology. 76(7):812-824. https://doi.org/10.1016/j.jacc.2020.06.043

MLA

Vancouver

Ameloot K, Jakkula P, Hästbacka J, Reinikainen M, Pettilä V, Loisa P o.a. Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest. Journal of the American College of Cardiology. 2020 aug 18;76(7):812-824. https://doi.org/10.1016/j.jacc.2020.06.043

Author

Ameloot, Koen ; Jakkula, Pekka ; Hästbacka, Johanna ; Reinikainen, Matti ; Pettilä, Ville ; Loisa, Pekka ; Tiainen, Marjaana ; Bendel, Stepani ; Birkelund, Thomas ; Belmans, Ann ; Palmers, Pieter Jan ; Bogaerts, Eline ; Lemmens, Robin ; De Deyne, Cathy ; Ferdinande, Bert ; Dupont, Matthias ; Janssens, Stefan ; Dens, Joseph ; Skrifvars, Markus B. / Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest. I: Journal of the American College of Cardiology. 2020 ; Bind 76, Nr. 7. s. 812-824.

Bibtex

@article{9ee2a974c8a34974b50678f3a82539bc,
title = "Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest",
abstract = "Background: In patients with shock after acute myocardial infarction (AMI), the optimal level of pharmacologic support is unknown. Whereas higher doses may increase myocardial oxygen consumption and induce arrhythmias, diastolic hypotension may reduce coronary perfusion and increase infarct size. Objectives: This study aimed to determine the optimal mean arterial pressure (MAP) in patients with AMI and shock after cardiac arrest. Methods: This study used patient-level pooled analysis of post-cardiac arrest patients with shock after AMI randomized in the Neuroprotect (Neuroprotective Goal Directed Hemodynamic Optimization in Post-cardiac Arrest Patients; NCT02541591) and COMACARE (Carbon Dioxide, Oxygen and Mean Arterial Pressure After Cardiac Arrest and Resuscitation; NCT02698917) trials who were randomized to MAP 65 mm Hg or MAP 80/85 to 100 mm Hg targets during the first 36 h after admission. The primary endpoint was the area under the 72-h high-sensitivity troponin-T curve. Results: Of 235 patients originally randomized, 120 patients had AMI with shock. Patients assigned to the higher MAP target (n = 58) received higher doses of norepinephrine (p = 0.004) and dobutamine (p = 0.01) and reached higher MAPs (86 ± 9 mm Hg vs. 72 ± 10 mm Hg, p < 0.001). Whereas admission hemodynamics and angiographic findings were all well-balanced and revascularization was performed equally effective, the area under the 72-h high-sensitivity troponin-T curve was lower in patients assigned to the higher MAP target (median: 1.14 μg.72 h/l [interquartile range: 0.35 to 2.31 μg.72 h/l] vs. median: 1.56 μg.72 h/l [interquartile range: 0.61 to 4.72 μg. 72 h/l]; p = 0.04). Additional pharmacologic support did not increase the risk of a new cardiac arrest (p = 0.88) or atrial fibrillation (p = 0.94). Survival with good neurologic outcome at 180 days was not different between both groups (64% vs. 53%, odds ratio: 1.55; 95% confidence interval: 0.74 to 3.22). Conclusions: In post-cardiac arrest patients with shock after AMI, targeting MAP between 80/85 and 100 mm Hg with additional use of inotropes and vasopressors was associated with smaller myocardial injury.",
keywords = "acute myocardial infarction, cardiac arrest, cardiogenic shock",
author = "Koen Ameloot and Pekka Jakkula and Johanna H{\"a}stbacka and Matti Reinikainen and Ville Pettil{\"a} and Pekka Loisa and Marjaana Tiainen and Stepani Bendel and Thomas Birkelund and Ann Belmans and Palmers, {Pieter Jan} and Eline Bogaerts and Robin Lemmens and {De Deyne}, Cathy and Bert Ferdinande and Matthias Dupont and Stefan Janssens and Joseph Dens and Skrifvars, {Markus B.}",
year = "2020",
month = aug,
day = "18",
doi = "10.1016/j.jacc.2020.06.043",
language = "English",
volume = "76",
pages = "812--824",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier",
number = "7",

}

RIS

TY - JOUR

T1 - Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest

AU - Ameloot, Koen

AU - Jakkula, Pekka

AU - Hästbacka, Johanna

AU - Reinikainen, Matti

AU - Pettilä, Ville

AU - Loisa, Pekka

AU - Tiainen, Marjaana

AU - Bendel, Stepani

AU - Birkelund, Thomas

AU - Belmans, Ann

AU - Palmers, Pieter Jan

AU - Bogaerts, Eline

AU - Lemmens, Robin

AU - De Deyne, Cathy

AU - Ferdinande, Bert

AU - Dupont, Matthias

AU - Janssens, Stefan

AU - Dens, Joseph

AU - Skrifvars, Markus B.

PY - 2020/8/18

Y1 - 2020/8/18

N2 - Background: In patients with shock after acute myocardial infarction (AMI), the optimal level of pharmacologic support is unknown. Whereas higher doses may increase myocardial oxygen consumption and induce arrhythmias, diastolic hypotension may reduce coronary perfusion and increase infarct size. Objectives: This study aimed to determine the optimal mean arterial pressure (MAP) in patients with AMI and shock after cardiac arrest. Methods: This study used patient-level pooled analysis of post-cardiac arrest patients with shock after AMI randomized in the Neuroprotect (Neuroprotective Goal Directed Hemodynamic Optimization in Post-cardiac Arrest Patients; NCT02541591) and COMACARE (Carbon Dioxide, Oxygen and Mean Arterial Pressure After Cardiac Arrest and Resuscitation; NCT02698917) trials who were randomized to MAP 65 mm Hg or MAP 80/85 to 100 mm Hg targets during the first 36 h after admission. The primary endpoint was the area under the 72-h high-sensitivity troponin-T curve. Results: Of 235 patients originally randomized, 120 patients had AMI with shock. Patients assigned to the higher MAP target (n = 58) received higher doses of norepinephrine (p = 0.004) and dobutamine (p = 0.01) and reached higher MAPs (86 ± 9 mm Hg vs. 72 ± 10 mm Hg, p < 0.001). Whereas admission hemodynamics and angiographic findings were all well-balanced and revascularization was performed equally effective, the area under the 72-h high-sensitivity troponin-T curve was lower in patients assigned to the higher MAP target (median: 1.14 μg.72 h/l [interquartile range: 0.35 to 2.31 μg.72 h/l] vs. median: 1.56 μg.72 h/l [interquartile range: 0.61 to 4.72 μg. 72 h/l]; p = 0.04). Additional pharmacologic support did not increase the risk of a new cardiac arrest (p = 0.88) or atrial fibrillation (p = 0.94). Survival with good neurologic outcome at 180 days was not different between both groups (64% vs. 53%, odds ratio: 1.55; 95% confidence interval: 0.74 to 3.22). Conclusions: In post-cardiac arrest patients with shock after AMI, targeting MAP between 80/85 and 100 mm Hg with additional use of inotropes and vasopressors was associated with smaller myocardial injury.

AB - Background: In patients with shock after acute myocardial infarction (AMI), the optimal level of pharmacologic support is unknown. Whereas higher doses may increase myocardial oxygen consumption and induce arrhythmias, diastolic hypotension may reduce coronary perfusion and increase infarct size. Objectives: This study aimed to determine the optimal mean arterial pressure (MAP) in patients with AMI and shock after cardiac arrest. Methods: This study used patient-level pooled analysis of post-cardiac arrest patients with shock after AMI randomized in the Neuroprotect (Neuroprotective Goal Directed Hemodynamic Optimization in Post-cardiac Arrest Patients; NCT02541591) and COMACARE (Carbon Dioxide, Oxygen and Mean Arterial Pressure After Cardiac Arrest and Resuscitation; NCT02698917) trials who were randomized to MAP 65 mm Hg or MAP 80/85 to 100 mm Hg targets during the first 36 h after admission. The primary endpoint was the area under the 72-h high-sensitivity troponin-T curve. Results: Of 235 patients originally randomized, 120 patients had AMI with shock. Patients assigned to the higher MAP target (n = 58) received higher doses of norepinephrine (p = 0.004) and dobutamine (p = 0.01) and reached higher MAPs (86 ± 9 mm Hg vs. 72 ± 10 mm Hg, p < 0.001). Whereas admission hemodynamics and angiographic findings were all well-balanced and revascularization was performed equally effective, the area under the 72-h high-sensitivity troponin-T curve was lower in patients assigned to the higher MAP target (median: 1.14 μg.72 h/l [interquartile range: 0.35 to 2.31 μg.72 h/l] vs. median: 1.56 μg.72 h/l [interquartile range: 0.61 to 4.72 μg. 72 h/l]; p = 0.04). Additional pharmacologic support did not increase the risk of a new cardiac arrest (p = 0.88) or atrial fibrillation (p = 0.94). Survival with good neurologic outcome at 180 days was not different between both groups (64% vs. 53%, odds ratio: 1.55; 95% confidence interval: 0.74 to 3.22). Conclusions: In post-cardiac arrest patients with shock after AMI, targeting MAP between 80/85 and 100 mm Hg with additional use of inotropes and vasopressors was associated with smaller myocardial injury.

KW - acute myocardial infarction

KW - cardiac arrest

KW - cardiogenic shock

UR - http://www.scopus.com/inward/record.url?scp=85088944431&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2020.06.043

DO - 10.1016/j.jacc.2020.06.043

M3 - Journal article

C2 - 32792079

AN - SCOPUS:85088944431

VL - 76

SP - 812

EP - 824

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 7

ER -