Milrinone and mortality in adult cardiac surgery: A meta-analysis

Alberto Zangrillo, Giuseppe Biondi-Zoccai, Martin Ponschab, Massimiliano Greco, Laura Corno, Remo Daniel Covello, Luca Cabrini, Elena Bignami, Giulio Melisurgo, Giovanni Landoni

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The authors conducted a review of randomized studies to show whether there are any increases or decreases in survival when using milrinone in patients undergoing cardiac surgery. Design: A meta-analysis. Setting: Hospitals. Participants: Five hundred eighteen patients from 13 randomized trials. Interventions: None. Measurements and Main Results: BioMedCentral, PubMed EMBASE, the Cochrane central register of clinical trials, and conference proceedings were searched for randomized trials that compared milrinone versus placebo or any other control in the setting of cardiac surgery that reported data on mortality. Overall analysis showed that milrinone increased perioperative mortality (13/249 [5.2%] in the milrinone group v 6/269 [2.2%] in the control arm, odds ratio [OR] = 2.67 [1.05-6.79], p for effect = 0.04, p for heterogeneity = 0.23, I 2 = 25% with 518 patients and 13 studies included). Subanalyses confirmed increased mortality with milrinone (9/84 deaths [10.7%] v 3/105 deaths [2.9%] with other drugs as control, OR = 4.19 [1.27-13.84], p = 0.02) with 189 patients and 5 studies included) but did not confirm a difference in mortality (4/165 [2.4%] in the milrinone group v 3/164 [1.8%] with placebo or nothing as control, OR = 1.27 [0.28-5.84], p = 0.76 with 329 patients and 8 studies included). Conclusions: This analysis suggests that milrinone might increase mortality in adult patients undergoing cardiac surgery. The effect was seen only in patients having an active inotropic drug for comparison and not in the placebo subgroup. Therefore, the question remains whether milrinone increased mortality or if the control inotropic drugs were more protective.

Original languageEnglish
Pages (from-to)70-77
Number of pages8
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume26
Issue number1
DOIs
Publication statusPublished - Feb 2012

Keywords

  • anesthesia
  • cardiac surgery
  • complications
  • heart failure
  • inotropic agents
  • intensive care
  • milrinone
  • mortality
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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