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Meta-analysis of randomized trials of effect of milrinone on mortality in cardiac surgery: an update

David T Majure1, Teresa Greco, Massimiliano Greco

  • 1Department of Medicine, University of California, San Francisco, CA, USA.

Journal of Cardiothoracic and Vascular Anesthesia
|October 16, 2012
PubMed
Abstract

Insights

This meta-analysis found no significant difference in mortality for patients receiving milrinone during cardiac surgery. However, high-quality trials showed a trend toward increased mortality with milrinone use.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Long-term milrinone use is linked to higher mortality in chronic heart failure.
  • Previous meta-analyses suggested a potential increase in mortality with milrinone in cardiac surgery patients.
  • Updated meta-analysis needed to clarify milrinone's impact on survival during cardiac surgery.

Purpose of the Study:

  • To conduct an updated meta-analysis of randomized trials.
  • To determine if milrinone administration impacts survival in patients undergoing cardiac surgery.
  • To evaluate the safety and efficacy of milrinone in this patient population.

Main Methods:

  • Systematic search of multiple databases (Biomed Central, PubMed, EMBASE, Cochrane) and conference proceedings.
  • Inclusion of 20 randomized trials involving 1,037 patients (adults and pediatric).
  • Contacting authors for mortality data when not explicitly reported in trials.

Main Results:

  • Overall analysis revealed no significant difference in mortality between milrinone and control groups (RR = 1.15; 95% CI, 0.55-2.43).
  • Analysis restricted to adult patients also showed no significant difference in mortality (RR = 1.17; 95% CI, 0.54-2.53).
  • Sensitivity analysis of high-quality trials indicated a trend towards increased mortality with milrinone (RR = 2.71; 95% CI, 0.82-9).

Conclusions:

  • The study could not confirm an adverse effect of intravenous milrinone on survival in cardiac surgery patients.
  • Theoretical concerns regarding increased mortality with milrinone remain.
  • A trend towards increased mortality was observed in high-quality trials, warranting further investigation.

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