Abstract 14535: Early β-blocker and Renin Angiotensin Aldosterone Blocker Therapy in Patients with Acute Myocardial Infarction and Ongoing Cardiogenic Shock is Associated with Increased 30 Day Mortality: Insights from the Triumph Trial
Background: Guidelines recommend β-blockers and Renin-Angiotensin-Aldosterone System (RAAS) blockers to improve short and long term survival in hemodynamically stable myocardial infarction (MI) patients with a reduced left ventricular ejection fraction. The incidence and outcomes associated with early β and RAAS blocker therapy in patients with ongoing cardiogenic shock (CS) remains unknown.
Methods: The TRIUMPH trial enrolled patients with acute MI and persistent CS despite an open infarct related artery. We compared the 30 day mortality in patients with CS lasting > 24 hours who received β or RAAS blockers within the first 24 hours after randomization with those who did not.
Results: The final study population included 240 patients enrolled between 2005 and 2006 in North America (47%) and Europe (53%) who had persistent CS lasting more than 24 hours. A total of 66 (27.5%) patients with CS had β or RAAS blockers administered within the first 24 hours after randomization. β-blockers, angiotensin converting enzyme inhibitors(ACE) or angiotensin receptor blockers (ARB), and aldosterone antagonists were used in 18.8%, 10.8% and 5.0% of patients, respectively. The observed 30 day mortality was higher in patients who received β or RAAS blockers prior to CS resolution (27.3% vs 16.9%; adjusted odds ratio [OR] 2.36: 95% Confidence Interval [CI], 1.04, to 5.23; p=0.035). Compared to patients not given β or RAAS 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 ACE or ARBs (18.2% vs 16.9%; p=1.000).
Conclusions: The administration of β or RAAS blockers prior to CS resolution, which is not supported by current guidelines, is common in North America and Europe. This therapeutic practice was independently associated with higher 30 day mortality; though a statistically significant difference was only observed in the subgroup of patients administered β blockers.
- © 2012 by American Heart Association, Inc.