GO-3 Dr. Ashida · 2020. 12. 11. · &2, 'lvforvxuh 7$'$6+, $6+,'$ 7kh dxwkruv kdyh qr ilqdqfldo frqiolfwv ri lqwhuhvw wr glvforvh frqfhuqlqj wkh suhvhqwdwlrq 7rn\r &&8 qhwzrun gdwd

http://www.ccunet-tokyo.jp

Tokyo CCU Network 40th Tokyo CCU研究会

Effect of Renal Function and Vasopressor Agents for Cardiogenic Shock due to Acute Myocardial Infarction:

Results from the Tokyo CCU Network Registry

Tadashi Ashida, Tsukasa Yagi, Norihiro Kuroki, Tadateru Takayama, Yusuke Hosokawa, Jun Nakata, Masanari Kuwabara, Takeshi Yamamoto, Ken Nagao, Morimasa Takayama

Tokyo CCU Network, Scientific Committee, Tokyo, Japan

Department of Cardiology, Nihon University Hospital

COI DisclosureTADASHI ASHIDA

The authors have no financial conflicts of interest to disclose concerning the presentation.

Tokyo CCU network data registry isfinancially supported by Tokyo Metropolitan Government



Introduction

In the guidelines1) for cardiogenic shock, noradrenaline, as compared with dopamine, was associated with fewer cases of arrhythmia and may be a better first-line vasopressor agent.

However, few clinical studies have investigated the effects of optimal first-line vasopressor agents for patients with poor renal function.

1)van Diepen S, et al. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136: e232-e268



Objectives

The aim of this study was to evaluate the usefulness of noradrenaline versus dopamine in patients with cardiogenic shock due to acute myocardial infarction (AMI), and to clarify the effects of vasopressor use in patients depending on the presence of renal dysfunction at hospitalization.



Methods 1

From a multicenter, prospective, cohort registry of emergency cardiovascular patients in Tokyo CCU network registry between 2013 and 2016, we identified adult patients with cardiogenic shock due to AMI who received either noradrenaline, dopamine or both as a vasopressor agent without mechanical circulatory supports.



Methods 2Study patients were divided into 4 groups according to estimated glomerular filtration rate (eGFR).

The primary endpoint was all-cause death at 30 days after admission.

We compared all cause death at 30 days after admission, using the multivariable logistic regression analysis.



Methods 3Potential confounding factors based on biological plausibility and previous studies2),3) were included in the multivariable logistic regression analysis.

These variables included the age, sex (male, female), systolic blood pressure at emergency department (ED) arrival, heart rate at ED arrival, eGFR, and consciousness disturbance (Japan coma scale).

2)De Backer D, et al. Comparison of dopamine and norepinephrine in thetreatment of shock. N Engl J Med 2010; 362: 779 7893)Ueki Y, et al.. Characteristics and Predictors of Mortality in Patients WithCardiovascular Shock in Japan Results From the Japanese CirculationSociety Cardiovascular Shock Registry. Circ J 2016; 80: 852 859



Results 1 Study Profile

419 The administration of noradrenaline

(N group)

92 Both agents(B group)

154 The administration of dopamine(D group)

4034 All adult cardiogenic shock patients due to AMI in Tokyo CCU network registry from 2013 to 2016

Exclusion criteria1. Systolic blood pressure < 60mmHg2. Patients with the administration of neither norepinephrine nor dopamine3. Patients with mechanical circulatory support

665 Adult patients with cardiogenic shock due to AMI who received either noradrenaline, dopamine or both as a vasopressor agent without mechanical circulatory supports.



Results 2 Baseline CharactersBaseline Characters N group D group B group P

Age-yr mean ± SD 72.3 ± 13.2 71.0 ± 13.9 76.1 ± 11.3 0.012

Male sex - no. (%) 278 (66.3) 108 (69.2) 60 (65.2) 0.891

Systolic blood pressure at ED mean ± SD 108 ± 31 105 ± 26 104 ± 27 0.305

Heart rate at ED mean ± SD 76 ± 28 75 ± 28 82 ± 33 0.163

eGFR mean ± SD 72.1 ± 39.7 52.5 ± 24.1 51.0 ± 41.1 0.728

Non-consciousness disturbance – no. (%) 250 (61.1) 97 (62.2) 45 (51.1) 0.182



Results 3

0%

20%

40%

60%

N group D group B group

P

Results 3

0%

20%

40%

60%

Ngroup

Dgroup

Bgroup

0%

20%

40%

60%

Ngroup

Dgroup

Bgroup

0%

5%

10%

15%

20%

Ngroup

Dgroup

Bgroup

Mo

rtal

ity

to d

isch

arg

e

1) CKD stage G0/1/2 (n=232)

p=0.052

0%

20%

40%

60%

Ngroup

Dgroup

Bgroup

2) CKD stage G3a (n=161)

p

Adjusted Odds Ratio (95% CI)

Survival DeathVariable 0.1 1.0 10.0

1.065 (1.039 - 1.092)Age - yr

1.198 (0.712 – 2.015)

3.176 (1.722 – 5.857)

Male-gender (reference female)

Administration of vasopressor agents

Systolic blood pressure on Emergency Department 0.998 (0.990 – 1.006)

1.026 (1.018 – 1.035)

0.399 (0.190 – 0.841)0.844 (0.380 – 1.873)

Consciousness disturbance (Japan Coma Scale)

eGFR

Noradrenaline (reference)

Dopamine

Both

Heart rate on Emergency Department

JCS 0JCS 1-3

JCS 10-30JCS 100-300 (reference)

1.353 (0.486 – 3.769)

CKD stage G0/1/2 (reference)

CKD stage 3a

CKD stage 3b

CKD stage 4/5

3.300 (1.270 – 8.574)

4.746 (1.565 – 14.39)

13.24 (3.283 – 53.48)

0.505 (0.256 – 0.996)

Results 4Tokyo CCU Network 40th Tokyo CCU研究会


Discussion

Noradrenaline exerts a predominant vasoconstrictive effect through alpha-adrenoceptor stimulation and inotropic and chronotropic effects through alpha1 and beta1 adrenoceptors.

Especially, the vasoconstrictive effect by administration of noradrenaline causes decrease of renal blood flow.



Conclusion

Compared with noradrenaline, dopamine was associated with a lower all-cause mortality rate for patients with cardiogenic shock due to AMI. Randomized controlled trials are required to confirm these findings.



Documents

GO-3 Dr. Ashida · 2020. 12. 11. · &2, 'lvforvxuh 7$'$6+, $6+,'$ 7kh dxwkruv kdyh qr ilqdqfldo frqiolfwv ri lqwhuhvw wr glvforvh frqfhuqlqj wkh suhvhqwdwlrq 7rn\r &&8 qhwzrun gdwd