Shock in acute myocardial infarction: the Cape Horn for trials?

Abstract

Despite therapeutic improvements, cardiogenic shock (CS) remains the most common cause of death in patients with acute myocardial infarction (AMI). In addition to percutaneous coronary intervention, inotropes, fluids, adjunctive medication, intra-aortic balloon counterpulsation, and also assist devices are widely used for treatment. However, currently, there is only limited evidence for any of the above treatments. This review will therefore outline the underlying causes, pathophysiology, and treatment of CS complicating AMI with major focus on interventional techniques and advancement of new therapeutical arsenals, both pharmacological and mechanical.

Predictors of mortality in patients with cardiogenic shock treated with primary percutaneous coronary intervention and intra-aortic balloon counterpulsation

“…Cardiogenic shock (CS) affects 5-8% of patients with acute myocardial infarction (AMI) (Thiele et al, 2010). Although modern revascularization strategies have achieved a significant mortality reduction (Hochmann et al, 1999), CS remains the most serious complication of patients hospitalized for AMI, and mortality is still approaching 50%.…”

What is extracorporeal cardiopulmonary resuscitation?

“…This situation is analogue to MCS use in cardiogenic shock, where the organisation of a RCT on a life-saving technique is ethically unacceptable, beyond the wellknown statistical obstacles in the attainment of a sample size sufficient to infer on mortality (39). Therefore, from our point of view, an increase of our knowledge could be obtained only through a clear definition of ECPR and related questions, allowing for a correct interpretation of our present and future data.…”

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

“…This severe cardiac dysfunction causes tissue hypoperfusion and may eventually result in death if the vicious cycle is not adequately interrupted by timely treatment measures. In addition to the physiological impairment of myocardial function, cardiogenic shock also induces deleterious systemic responses including pathological vasodilation (after compensatory vasoconstriction), systemic inflammation with capillary leakage and impairment of the microcirculation 1, 3 . This review will look at the optimal management of patients with cardiogenic shock complicating acute myocardial infarction with particular focus on revascularisation therapy and the use of mechanical circulatory support devices.…”