In patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS), vasopressors and inotropes are widely used to stabilize circulation. However, their effect on survival remains uncertain. We performed a systematic review of MEDLINE, EMBASE, and CENTRAL through 20 February 2019, including both randomized and observational studies reporting mortality in AMI-related CS. Eligible studies compared patients receiving at least one vasopressor or inotrope with those who did not receive such therapy. Studies limited to post-cardiac surgery patients, case reports, and correspondence were excluded. Nineteen studies (six randomized trials) involving 2,478 patients were analyzed, though the overall quality of evidence was low. No vasopressor or inotrope—including adrenaline, noradrenaline, vasopressin, milrinone, levosimendan, dobutamine, or dopamine—was consistently associated with reduced mortality. Levosimendan showed a trend toward improved outcomes (RR 0.69, 95% CI 0.47–1.00). These results highlight the limited evidence supporting survival benefits from standard vasopressors or inotropes in AMI-related CS and underscore the need for rigorously designed randomized trials to clarify their role.
