Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/32954
Title: Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest
Authors: AMELOOT, Koen 
Jakkula, Pekka
Haestbacka, Johanna
Reinikainen, Matti
Pettila, Ville
Loisa, Pekka
Tiainen, Marjaana
Bendel, Stepani
Birkelund, Thomas
Belmans, Ann
Palmers, Pieter-Jan
BOGAERTS, Eric 
Lemmens, Robin
DE DEYNE, Cathy 
Ferdinande, Bert
DUPONT, Matthias 
Janssens, Stefan
DENS, Jo 
Skrifvars, Markus B.
Issue Date: 2020
Publisher: ELSEVIER SCIENCE INC
Source: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 76 (7) , p. 812 -824
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 mu g.72 h/l [interquartile range: 0.35 to 2.31 mu g.72 h/l] vs. median: 1.56 mu g.72 h/l [interquartile range: 0.61 to 4.72 mu g. 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. (C) 2020 by the American College of Cardiology Foundation.
Notes: Ameloot, K (corresponding author), Ziekenhuis Oost Limburg, Schiepse Bos 6, B-3600 Genk, Belgium.
Koen.ameloot@zol.be
Other: Ameloot, K (corresponding author), Ziekenhuis Oost Limburg, Schiepse Bos 6, B-3600 Genk, Belgium. Koen.ameloot@zol.be
Keywords: acute myocardial infarction;cardiac arrest;cardiogenic shock
Document URI: http://hdl.handle.net/1942/32954
ISSN: 0735-1097
e-ISSN: 1558-3597
DOI: 10.1016/j.jacc.2020.06.043
ISI #: WOS:000561615600007
Category: A1
Type: Journal Contribution
Validations: ecoom 2021
Appears in Collections:Research publications

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