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BMC Cardiovascular Disorders

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Open Access 01-12-2020 | Myocardial Infarction | Research article

The effect of milrinone on mortality in adult patients who underwent CABG surgery: a systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis

Authors: Yu-shan Ren, Lan-fang Li, Tao Peng, Yu-jun Tan, Ying Sun, Guo-liang Cheng, Gui-min Zhang, Jie Li

Published in: BMC Cardiovascular Disorders | Issue 1/2020

Abstract

Background

As an inodilator, milrinone is commonly used for patients who undergo coronary artery bypass graft (CABG) surgery because of its effectiveness in decreasing the cardiac index and mitral regurgitation. The aim of this study was to perform a systematic review and meta-analysis of existing studies from the past 20 years to evaluate the impact of milrinone on mortality in patients who undergo CABG surgery.

Methods

We performed a systematic literature search on the application of milrinone in patients who underwent CABG surgery in studies published between 1997 and 2017 in BioMed Central, PubMed, EMBASE, and the Cochrane Central Register. The included studies evaluated milrinone groups compared to groups receiving either placebo or standard treatment and further compared the systemic administration.

Results

The network meta-analysis included 723 patients from 16 randomized clinical trials. Overall, there was no significant difference in mortality between the milrinone group and the placebo/standard care group when patients underwent CABG surgery. In addition, 9 trials (with 440 randomized patients), 4 trials (with 212 randomized patients), and 10 trials (with 470 randomized patients) reported that the occurrence of myocardial infarction (MI), myocardial ischemia, and arrhythmia was lower in the milrinone group than in the placebo/standard care group. Between the milrinone treatment and placebo/standard care groups, the occurrence of myocardial infarction, myocardial ischemia, and arrhythmia was significantly different. However, the occurrence of stroke and renal failure, the duration of inotropic support (h), the need for an intra-aortic balloon pump (IABP), and mechanical ventilation (h) between these two groups showed no differences.

Conclusions

Based on the current results, compared with placebo, milrinone might be unable to decrease mortality in adult CABG surgical patients but can significantly ameliorate the occurrence of MI, myocardial ischemia, and arrhythmia. These results provide evidence for the further clinical application of milrinone and of therapeutic strategies for CABG surgery. However, along with milrinone application in clinical use, sufficient data from randomized clinical trials need to be collected, and the potential benefits and adverse effects should be analyzed and reevaluated.

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Title: The effect of milrinone on mortality in adult patients who underwent CABG surgery: a systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis
Authors: Yu-shan Ren
Lan-fang Li
Tao Peng
Yu-jun Tan
Ying Sun
Guo-liang Cheng
Gui-min Zhang
Jie Li
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Myocardial Infarction
Intra-Aortic Balloon
Milrinone
CABG
CABG
Published in: BMC Cardiovascular Disorders / Issue 1/2020
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/s12872-020-01598-8

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Activating the interleukin-6-Gp130-STAT3 pathway ameliorates ventricular electrical stability in myocardial infarction rats by modulating neurotransmitters in the paraventricular nucleus

Prevalence of obstructive sleep apnoea in acute coronary syndrome patients: systematic review and meta-analysis

Phosphodiesterase 5 inhibitor sildenafil in patients with heart failure with preserved ejection fraction and combined pre- and postcapillary pulmonary hypertension: a randomized open-label pilot study

Anomalous right coronary artery with interarterial course depicting an unusual case of an electrical storm: a case presentation

Diagnostic and predictive value of speckle tracking echocardiography in cardiac sarcoidosis

Community-level socioeconomic inequality in the incidence of ischemic heart disease: a nationwide cohort study

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page