Mean Arterial Pressure and Mortality in Infarction-Related Cardiogenic Shock with and without Cardiac Arrest: A Meta-Analysis

BACKGROUND: This comprehensive systematic review and meta-analysis aimed to evaluate the effect of different mean arterial pressure (MAP) levels on short-term mortality in patients with acute myocardial infarction complicated by cardiogenic shock with cardiac arrest (AMICS-CA) and without (AMICS without CA).

METHODS AND RESULTS: We conducted a systematic search of MEDLINE (OVID), EMBASE (OVID), CINAHL (Ebsco) and Cochrane CENTRAL databases. Studies that reported outcomes for AMICS patients with and without CA in at least two MAP groups of different MAP levels were eligible, including targeted MAPs in the randomized clinical trials (RCTs) and achieved average MAPs in the observational studies. Authors of the included studies were proactively contacted for additional AMI data. Data were pooled using random-effects models. The primary endpoint was short-term mortality. Of 11,269 screened studies, 12 were included in the final analysis (4 RCTs and 8 observational studies), encompassing 1281 AMICS-CA patients and 111 AMICS patients without CA. Short-term mortality was similar between low- and high-MAP groups in AMICS-CA in both RCTs (34.9% vs. 39.4%, RR 0.88, 95%-CI 0.70-1.10) and observational data, as well as in AMICS patients without CA, although based on just two observational studies.

CONCLUSIONS: Our meta-analysis showed no significant difference in short-term mortality between low- and high-MAP levels in AMICS patients with CA. Similarly, although based on pooled observational data from only two studies, no significant difference in mortality was observed in AMICS patients without CA. Overall, both limited evidence and heterogeneity in low- and high-MAP definitions across studies preclude firm conclusions.