Clinical Importance of Phosphodiesterase 3 Inhibitors on Outcomes in Patients With Cardiogenic Shock　― A Systematic Review ―

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Background: Inotropes play a significant role in the treatment of cardiogenic shock (CS). Phosphodiesterase 3 inhibitors (PDE3i) are being used with increasing frequency, despite limited supporting evidence.

Methods and Results: We performed a systematic review to assess the clinical importance of PDE3i in CS. The search included studies that compared the effect of ‘PDE3i with or without inotropes’ with ‘No PDE3i with or without inotropes’ in patients with cardiogenic shock. Early death, cardiac arrest, and initiation of renal replacement therapy were assessed as outcomes. We identified 2 randomized controlled trials (RCT) with a total of 224 patients who met the eligibility requirements from the PubMed, Web of Science, and CENTRAL databases, up until October 31, 2024. One RCT compared milrinone with dobutamine (DOB), and another compared enoximone with levosimendan. Meta-analysis revealed that PDE3i were neither superior nor inferior for the outcomes in the total cohort (odds ratio [OR] 1.47, 95% confidence interval [CI] 0.35–6.26 for early deaths; OR 1.14, 95% CI 0.42–3.14 for cardiac arrest; OR 1.53, 95% CI 0.80–2.92 for the initiation of renal replacement therapy).

Conclusions: The present systematic review revealed no difference in outcomes, early deaths, cardiac arrest and initiation of renal replacement therapy when using PDE3i in patients with CS treated with or without other inotropes.