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: We conducted a systematic search of MEDLINE (OVID), EMBASE (OVID), CINAHL (Ebsco), and Cochrane CENTRAL databases. Studies that reported outcomes for patients with AMICS with and without CA in at least 2 groups of different MAP levels were eligible, including targeted MAPs in randomized clinical trials (RCTs) and achieved average MAPs in 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. RESULTS: Of 11,269 screened studies, 12 were included in the final analysis (4 RCTs and 8 observational studies), encompassing 1281 patients with AMICS-CA and 111 patients with AMICS without CA. Short-term mortality was similar between low- and high-MAP groups in AMICS-CA in both RCTs (34.9% vs 39.4%, Risk Ratio 0.88, 95% confidence interval, 0.70-1.10) and observational data, as well as in patients with AMICS without CA, although based on just 2 observational studies. CONCLUSIONS: Our meta-analysis showed no significant difference in short-term mortality between low- and high-MAP levels in patients with AMICS with CA. Similarly, although based on pooled observational data from only 2 studies, no significant difference in mortality was observed in patients with AMICS without CA. Overall, both limited evidence and heterogeneity in low- and high-MAP definitions across studies preclude firm conclusions.