<b>Outcomes of Pharmacologic and Mechanical Therapies in Cardiogenic Shock: A Meta-analysis Stratified by Severity and Time to Intervention</b>
<p dir="ltr"><b>Background:</b></p><p dir="ltr">Effective management of cardiogenic shock (CGS) depending on the severity and the timing of intervention is crucial for patient survival. This study will explore the effectiveness of different medicatio...
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2025
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| Summary: | <p dir="ltr"><b>Background:</b></p><p dir="ltr">Effective management of cardiogenic shock (CGS) depending on the severity and the timing of intervention is crucial for patient survival. This study will explore the effectiveness of different medications and mechanical circulatory support devices (MCSDs) across above factors.</p><p dir="ltr"><b>Methods:</b></p><p dir="ltr">We searched online databases via Google Scholar, PubMed, PLOS one, and Medline on April 10, 2025. The selected trails included patients age > 18 years with CGS secondary to myocardial infarction (MI), showing baseline characteristics and early mortality data. Mortality outcomes and heterogeneity among medications and MCSDs were demonstrated using forest plots. Robvis was used to present risk of bias plot while certainty of evidence was assessed using GRADE criteria.</p><p dir="ltr"><b>Results:</b></p><p dir="ltr">Nineteen studies (n=3251 participants) were included. Early intervention in classic CGS, norepinephrine (0.27) and levosimendan (0.27) were associated with the lowest early mortality although levosimendan had very low certainty. In profound shock, dopamine (0.00, 95% CI 0.00–0.07) and norepinephrine (0.00, 95% CI 0.00–0.07) both demonstrated low mortality, with low-certainty evidence. Delayed intervention favored levosimendan (0.25) and ivabradine (0.07), though ivabradine yielded low certainty. Pharmacologic therapies showed substantial heterogeneity. Among MCSDs, micro-axial pumps used pre-PCI had higher survival (0.46) and moderate heterogeneity (I²=31.5%) while post-PCI Intra-aortic balloon pumps (IABP) used in profound shock showed low mortality (0.40) and no heterogeneity (I²=0%)</p><p dir="ltr"><b>Conclusion:</b></p><p dir="ltr">Early initiation of norepinephrine displayed lower mortality in classic CGS, while levosimendan yielded better outcomes in the delayed intervention subset. Micro-axial pump devices gave better outcomes when used before or during PCI in classic shock.</p> |
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