Milrinone and Mortality in Adult Cardiac Surgery: A Meta-analysis

Objective: The authors conducted a review of randomized
studies to show whether there are any increases or decreases
in survival when using milrinone in patients undergoing
cardiac surgery.
Design: A meta-analysis.
Setting: Hospitals.
Participants: Five hundred eighteen patients from 13 randomized
trials.
Interventions: None.
Measurements and Main Results: BioMedCentral, PubMed
EMBASE, the Cochrane central register of clinical trials, and
conference proceedings were searched for randomized trials
that compared milrinone versus placebo or any other control
in the setting of cardiac surgery that reported data on
mortality. Overall analysis showed that milrinone increased
perioperative mortality (13/249 [5.2%] in the milrinone
group v 6/269 [2.2%] in the control arm, odds ratio [OR]
2.67 [1.05-6.79], p for effect 0.04, p for heterogeneity
0.23, I2 25% with 518 patients and 13 studies included).
Subanalyses confirmed increased mortality with milrinone
(9/84 deaths [10.7%] v 3/105 deaths [2.9%] with other drugs
as control, OR 4.19 [1.27-13.84], p 0.02) with 189 patients
and 5 studies included) but did not confirm a difference
in mortality (4/165 [2.4%] in the milrinone group v
3/164 [1.8%] with placebo or nothing as control, OR 1.27
[0.28-5.84], p 0.76 with 329 patients and 8 studies included).
Conclusions: This analysis suggests that milrinone might
increase mortality in adult patients undergoing cardiac surgery.
The effect was seen only in patients having an active
inotropic drug for comparison and not in the placebo subgroup.
Therefore, the question remains whether milrinone
increased mortality or if the control inotropic drugs were
more protective.