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Dobutamine versus milrinone in cardiogenic shock

AHA 2020
Capital Do-Re-Mi
A randomised clinical trial compared 2 inotropic agents that are often used to treat cardiogenic shock: milrinone and dobutamine. The results showed no difference in the primary composite outcome or in important individual components of the primary outcome [1]. Thus, the authors concluded that the choice might be based on physician comfort, cost, and individual response to therapy.

So far, little evidence has been available to guide physicians in their choice of inotropic agents for cardiogenic shock in clinical practice. Therefore, the Capital Do-Re-Mi trial (NCT03207165) was set up. It was designed as a double-blind, randomised controlled trial, including 192 cardiogenic shock patients with class B to E shock according to the classification of the Society for Cardiovascular Angiography and Interventions (SCAI). Participants were assigned 1:1 to milrinone or dobutamine for inotropic support. Therapy was titrated based on clinical, biochemical, and haemodynamic response. The primary outcome was a combined endpoint of in-hospital mortality, non-fatal myocardial infarction, stroke, new initiation of renal replacement therapy (RRT), need for mechanical circulatory support (MCS) or cardiac transplant, or cardiac arrest with successful resuscitation. Secondary outcomes included individual components of the primary outcome.

The primary outcome occurred in 49% (47 of 96 patients) in the milrinone group and in 54% (52 of 96) in the dobutamine group; the difference was not statistically significant (RR 0.90; 95% CI 0.69–1.19; P=0.47). There were also no differences in important secondary outcomes, including in-hospital mortality: 37% (35 of 96) versus 43% (41 of 96) (RR 0.85; 95% CI 0.60–1.21; P=0.38); and need for RRT: 22% (21 of 96) versus 17% (16 of 96) (RR 1.31; 95% CI 0.73–2.36; P=0.36).

    1. Mathew R, et al. Capital Do-Re-Mi: A Randomized Trial of Dobutamine Compared to Milrinone in Cardiogenic Shock. Abstract 125, AHA Scientific Sessions 2020, 13–17 Nov.


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