determined, but the early difference in the rate
of death suggests that the higher heart rate with
dopamine may have contributed to the occurrence
of ischemic events. Whatever the mechanism may
be, these data strongly challenge the current American
College of Cardiology–American Heart Association
guidelines, which recommend dopamine
as the first-choice agent to increase arterial pressure
among patients who have hypotension as a
result of an acute myocardial infarction.7
This study has several limitations. First, dopamine
is a less potent vasopressor than norepinephrine;
however, we used infusion rates that