Clinical Outcome and Cost-effectiveness of Reduced Noradrenaline by Using a Lower Blood Pressure Target in Patients With Cardiogenic Shock From Acute Myocardial Infarction
Objective: With this study the investigators aim to investigate the (cost-)effectiveness of reduced noradrenaline in patients with CS by using a lower MAP target of ≥ 55 mmHg, compared to ≥ 65 mmHg. The investigators hypothesize that reduced use of noradrenaline will improve overall survival and decrease renal failure requiring renal replacement therapy. Study design: Open label, randomized controlled multicenter trial Study population: Adults patients with CS due to AMI Intervention: Treatment strategy of reduced noradrenaline, by using a lower MAP target ( ≥ 55 mmHg). Main study endpoint: composite of all-cause mortality and severe renal failure leading to renal replacement therapy within 30-days after randomization.
• Acute myocardial infarction, STEMI or NSTEMI
• Early revascularization by PCI
• Cardiogenic shock, characterized by:
⁃ I. a. Systolic blood pressure (SBP) ≤ 90 mmHg for \> 30 minutes, OR b. Use of drugs to maintain SBP \> 90 mmHg at randomization.
⁃ II. Clinical signs of impaired organ perfusion with at least one of the following criteria:
• Altered mental status
• Cold, clammy skin and extremities
• Oliguria with urine output \< 30ml/hour
• Serum lactate \> 2.0 mmol/L
⁃ III. Clinical signs of pulmonary congestion