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Mean Arterial Pressure and Mortality in Infarction-Related Cardiogenic Shock With and Without Cardiac Arrest: A
S Ten Berg1, M Bogerd1, E J Peters1
1Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Journal of Cardiac Failure
|January 4, 2026
Summary
This study found no significant difference in short-term mortality for acute myocardial infarction with cardiogenic shock and cardiac arrest (AMICS-CA) patients treated with different mean arterial pressure (MAP) levels. Similar results were observed for AMICS patients without cardiac arrest.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Research
Background:
- Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is a critical condition.
- Cardiac arrest (CA) further complicates AMI with CS, increasing mortality risk.
- Optimizing hemodynamic management, including mean arterial pressure (MAP), is crucial for these patients.
Purpose of the Study:
- To systematically review and meta-analyze the impact of varying MAP levels on short-term mortality in patients with AMI complicated by CS, with and without CA.
- To compare outcomes between low-MAP and high-MAP management strategies.
Main Methods:
- A comprehensive systematic search of major medical databases (MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL) was performed.
- Included studies reported short-term mortality for AMI patients with and without CA across different MAP groups (targeted or achieved).
- Data from 12 studies (4 RCTs, 8 observational) involving 1281 AMICS-CA and 111 AMICS patients without CA were pooled using random-effects models.
Main Results:
- In patients with AMI complicated by CS and CA (AMICS-CA), short-term mortality was similar between low- and high-MAP groups in both RCTs (34.9% vs. 39.4%) and observational data.
- For AMICS patients without CA, mortality also showed no significant difference between low- and high-MAP groups, though this was based on only two observational studies.
- The primary endpoint, short-term mortality, did not significantly differ based on MAP levels in either patient group.
Conclusions:
- The meta-analysis indicates no significant difference in short-term mortality between low- and high-MAP levels for AMICS-CA patients.
- Similarly, no significant mortality difference was observed in AMICS patients without CA, although evidence is limited.
- Heterogeneity in MAP definitions and limited evidence across studies preclude definitive conclusions regarding optimal MAP targets.
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