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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
PubMed

Insights

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.
Abstract

Keywords:
Cardiogenic shockcardiac arrestmean arterial pressuremyocardial infarction

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