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Review
. 2023 Mar 11;12(6):2184.
doi: 10.3390/jcm12062184.

Contemporary Management of Cardiogenic Shock Complicating Acute Myocardial Infarction

Leonardo De Luca  1   2 , Raffaella Mistrulli  1 , Riccardo Scirpa  1 , Holger Thiele  3 , Giuseppe De Luca  4   5
Affiliations
Review

Contemporary Management of Cardiogenic Shock Complicating Acute Myocardial Infarction

Leonardo De Luca et al. J Clin Med. .

Abstract

Despite an improvement in pharmacological therapies and mechanical reperfusion, the outcome of patients with acute myocardial infarction (AMI) is still suboptimal, especially in patients with cardiogenic shock (CS). The incidence of CS accounts for 3-15% of AMI cases, with mortality rates of 40% to 50%. In contrast to a large number of trials conducted in patients with AMI without CS, there is limited evidence-based scientific knowledge in the CS setting. Therefore, recommendations and actual treatments are often based on registry data. Similarly, knowledge of the available options in terms of temporary mechanical circulatory support (MCS) devices is not equally widespread, leading to an underutilisation or even overutilisation in different regions/countries of these treatment options and nonuniformity in the management of CS. The aim of this article is to provide a critical overview of the available literature on the management of CS as a complication of AMI, summarising the most recent evidence on revascularisation strategies, pharmacological treatments and MCS use.

Keywords: acute myocardial infarction; cardiogenic shock; mechanical circulatory supports.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Causes of CS complicating AMI Ventricular failure subsequent to AMI remains the most frequent cause of CS. Mechanical complications of AMI represent less frequent causes (acute severe mitral regurgitation, ventricular septal rupture, free wall rupture): AMI, acute myocardial infarction; CS, cardiogenic shock.
Figure 2
Figure 2
The pyramid of CS classification, according to the Society of Cardiovascular Angiography and Interventions (SCAI).
Figure 3
Figure 3
Prevalence multivessel disease in infarct-related shock.
Figure 4
Figure 4
Main results of CULPRIT-SHOCK trial [17].
See this image and copyright information in PMC

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