Vasopressors and inotropes are routinely used in acute myocardial infarction (AMI)
related cardiogenic shock (CS) to improve hemodynamics. We aimed to investigate the effect of
routinely used vasopressor and inotropes on mortality in AMI related CS. A systematic search of
MEDLINE, EMBASE and CENTRAL was performed up to 20 February 2019. Randomized and
observational studies reporting mortality of AMI related CS patients were included. At least one
group should have received the vasopressor/inotrope compared with a control group not exposed to
the vasopressor/inotrope. Exclusion criteria were case reports, correspondence and studies including
only post-cardiac surgery patients. In total, 19 studies (6 RCTs) were included, comprising 2478 CS
patients. The overall quality of evidence was graded low. Treatment with adrenaline, noradrenaline,
vasopressin, milrinone, levosimendan, dobutamine or dopamine was not associated with a difference
in mortality between therapy and control group. We found a trend toward better outcome with
levosimendan, compared with control (RR 0.69, 95% CI 0.47–1.00). In conclusion, we found insufficient
evidence that routinely used vasopressors and inotropes are associated with reduced mortality in
patients with AMI related CS. Considering the limited evidence, this study emphasizes the need for
randomized trials with appropriate endpoints and methodology
