Cardiogenic shock: role of revascularization

The most common cause of cardiogenic shock is myocardial ischemia developing early or late in the course of acute myocardial infarction. The incidence of cardiogenic shock (CS) is around 7% in ST-segment elevation myocardial infarction (STEMI) patients and has remained constant over the last 20 years. Therapy should be chain based by increased patient's awareness. Early and prehospital diagnosis and treatment, with prompt transfer to a catheterization laboratory. Early revascularization is the cornerstone treatment of acute myocardial infarction complicated by cardiogenic shock. According to the guidelines, revascularization is effective up to 36 hours after the onset of CS and performed within 18 hours after the diagnosis of CS. Primary percutaneous coronary intervention (PCI) is the most efficient and easily available therapy to restore coronary flow in the infarct related artery. Although recommended, there is little evidence that immediate multivessel PCI is beneficial for CS. The growing numbers of reports suggest staged PCI procedures or CABG is preferred in CS patients with significant LM disease or 3-vessel disease. The use of hemodynamic support with newly available percutaneous left ventricular unloading devices may herald a new era enabling preservation of adequate perfusion to other vital organs such as the brain, kidney and bowel. Despite all current efforts, in-hospital mortality for CS remains around 50%. However, long-term outcome and quality of life in hospital survivors is similar to patients with ST-segment elevation myocardial infarction patients presenting without CS