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Review
. 2021 Nov 9;326(18):1840-1850.
doi: 10.1001/jama.2021.18323.

Cardiogenic Shock After Acute Myocardial Infarction: A Review

Marc D Samsky  1 , David A Morrow  2 , Alastair G Proudfoot  3   4   5 , Judith S Hochman  6 , Holger Thiele  7 , Sunil V Rao  1
Affiliations
Review

Cardiogenic Shock After Acute Myocardial Infarction: A Review

Marc D Samsky et al. JAMA. .

Erratum in

  • Erroneous Terminology in Review.
    [No authors listed] [No authors listed] JAMA. 2021 Dec 14;326(22):2333. doi: 10.1001/jama.2021.21381. JAMA. 2021. PMID: 34766969 Free PMC article. No abstract available.

Abstract

Importance: Cardiogenic shock affects between 40 000 and 50 000 people in the US per year and is the leading cause of in-hospital mortality following acute myocardial infarction.

Observations: Thirty-day mortality for patients with cardiogenic shock due to myocardial infarction is approximately 40%, and 1-year mortality approaches 50%. Immediate revascularization of the infarct-related coronary artery remains the only treatment for cardiogenic shock associated with acute myocardial infarction supported by randomized clinical trials. The Percutaneous Coronary Intervention Strategies with Acute Myocardial Infarction and Cardiogenic Shock (CULPRIT-SHOCK) clinical trial demonstrated a reduction in the primary outcome of 30-day death or kidney replacement therapy; 158 of 344 patients (45.9%) in the culprit lesion revascularization-only group compared with 189 of 341 patients (55.4%) in the multivessel percutaneous coronary intervention group (relative risk, 0.83 [95% CI, 0.71-0.96]; P = .01). Despite a lack of randomized trials demonstrating benefit, percutaneous mechanical circulatory support devices are frequently used to manage cardiogenic shock following acute myocardial infarction.

Conclusions and relevance: Cardiogenic shock occurs in up to 10% of patients immediately following acute myocardial infarction and is associated with mortality rates of nearly 40% at 30 days and 50% at 1 year. Current evidence and clinical practice guidelines support immediate revascularization of the infarct-related coronary artery as the primary therapy for cardiogenic shock following acute myocardial infarction.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Morrow reported receiving research grants to Brigham and Women’s Hospital from Abbott Laboratories, Amgen, Anthos, Arca Biopharma, AstraZeneca, Bayer Healthcare, Daiichi Sankyo, Eisai, and Merck; grants from Novartis, Pfizer, Quark, Regeneron, Roche Diagnostics, and Siemens; personal fees for consulting unrelated to shock from Bayer Healthcare, Merck, Novartis, and Roche Diagnostics; and personal fees from InCarda for data and safety monitoring board membership outside the submitted work and being a member of the TIMI Study Group, which has received institutional research grant support through Brigham and Women's Hospital from Abbott, Amgen, Anthos Therapeutics, AstraZeneca, Bayer HealthCare Pharmaceuticals, Daiichi-Sankyo, Eisai, Intarcia, MedImmune, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron Pharmaceuticals, Roche, Siemens Healthcare Diagnostics, The Medicines Company, and Zora Biosciences. Dr Proudfoot reported receiving grants from Abbott Vascular during the conduct of the study. Dr Rao reported receiving institutional research funding from Bayer and the National Heart, Lung, and Blood Institute outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.
Cardiogenic Shock Associated With Acute Myocardial Infarction
See this image and copyright information in PMC

Comment in

References

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