Shock management in acute myocardial infarction.
AIMS This manuscript outlines the treatment of cardiogenic shock (CS) complicating acute myocardial infarction (AMI) focusing on new therapeutic strategies from the interventional cardiologist's perspective. METHODS AND RESULTS CS is a life threatening complication of AMI occurring in 10% of AMI patients. It can be defined as a state of critical tissue and end organ hypoperfusion due to reduced cardiac contractility. Early revascularisation is the most important therapeutic measure. Its widespread use has caused a decline in the incidence of CS. However, despite optimal treatment, the mortality rate of CS is still approaches 50% It is now understood that CS not only involves the heart but the whole circulatory system. In order to increase the survival rates of CS patients, the right decisions have to be taken regarding the optimal revascularisation strategy, treatment with inotropes and vasopressors, mechanical left ventricular support, management of multiorgan dysfunction syndrome, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. CONCLUSIONS CS mortality remains unacceptably high. In the light of very limited evidence regarding most treatment modalities, there is a clear need for adequately designed studies in order to answer the numerous unsettled issues.
EuroIntervention journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology