Norepinephrine Versus Dopamine as Vasoactive Therapy in Cardiogenic Shock: Association With 28-Day Mortality in a...

BackgroundCardiogenic shock remains a life-threatening condition with persistently high mortality. Norepinephrine and dopamine are commonly used vasoactive agents; however, comparative data on clinical outcomes remain limited.MethodsThis retrospective cohort study included 388 adults with cardiogenic shock treated with norepinephrine (n = 72) or dopamine (n = 316) at King Chulalongkorn Memorial Hospital, Thailand. The primary outcome was 28-day mortality. Survival was evaluated using Kaplan-Meier analysis and Cox proportional hazards regression. Inverse probability of treatment weighting (IPTW) was applied to adjust for confounding by indication.ResultsMortality at 28 days occurred in 30.6% and 25.9% of the norepinephrine and dopamine groups, respectively. No statistically significant difference in 28-day mortality was observed in either the unadjusted (HR 0.84, 95% CI 0.52-1.34; P = .463) or IPTW-adjusted Cox proportional hazards model (HR 1.10, 95% CI 0.64-1.88; P = .725). Epinephrine rescue rates were comparable between groups (27.7% vs 24.2%; P = .551). Independent predictors of 28-day mortality included age ≥65 years, cardiopulmonary resuscitation, and epinephrine use (P < .001 for all), as well as renal replacement therapy and endotracheal intubation (P = .003 for both).ConclusionThe present study did not demonstrate a significant difference in 28-day mortality between norepinephrine and dopamine; however, dopamine was associated with a significantly higher incidence of arrhythmias.