Comparison of pressors for treatment of myocardial-infarction-related cardiogenic shock.
The SOAP II trial is the major RCT available comparing different vasopressors. However, it combines all types of shock. Norepinephrine looked better in the cardiogenic shock subgroup, but this also combines all types of cardiogenic shock. We want to determine what is the best pressor, specifically for myocardial-infarction-related cardiogenic shock.
http://www.ncbi.nlm.nih.gov/pubmed/20200382
http://www.nejm.org/doi/full/10.1056/NEJMoa0907118
MI defined as troponin-I or troponin-T > 1 mcg / L.
Cardiogenic shock defined as (cardiac output < 4 L / min AND wedge pressure > 12 mmHg) OR ICD-9 code for cardiogenic shock OR hit on "cardiogenic shock" free text in a clinical note.
How to run:
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Run queries troponin.sql, DataMarathon_V1.sql, and Presser_list.sql, in no particular order.
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Run "Andrew_Pulling it together.sql" and export the result of the final SELECT statement (for steps 1 and 2, see directed graph figure).
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Run stupid_dates.pl on the exported data.
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Run analysis.sas
Dopamine, n=118. In hospital mortaliy 46.6%
Norepinephrine n=44. In hospital mortaliy 68.2%
Both pressors ordered simultaneously, n=29. In hospital mortaliy 62.1%.
Fisher's exact P = 0.033.
Log-rank test for these curves, P = 0.004
Our results are unadjusted for any confounding by indication. Crude results suggest the dopamine group has better survival. This is in contrast to the SOAP II trial.
- Ben Geisler
- Erina Ghosh
- Miriam Makhlouf
- Andrew Ward
- Andy Zimolzak
This is code written by our team during the second Critical Data hackathon at MIT, September 5-7, 2014. We are querying the MIMIC II Database. This is a publicly and freely available clinical database that encompasses a large population of ICU patients and includes lab results, electronic documentation, and bedside monitor trends and waveforms..