Timing and treatment strategies according to SCAI classification in cardiogenic shock

Abstract

In patients with cardiogenic shock (CS), particularly those with acute myocardial infarction (AMI), evidence suggests that timely diagnosis and treatment interventions are critical in the prevention of haemo-metabolic compromise. Temporary mechanical circulatory support (tMCS) has shown potential in facilitating revascularization and recovery of patients with acute myocardial infarction cardiogenic shock (AMI-CS). Timing of treatment strategies for CS patients needs to be optimized for use of tMCS devices that are applicable to this heterogeneous patient population. Here, the latest evidence as well as the gaps in knowledge surrounding the role of time in the management of patients with CS is summarized.

Keywords: Acute myocardial infarction; Cardiogenic shock; Mechanical circulatory support; Timing.

Figure 1

Understanding the interplay between the time of tMCS implantation and outcomes in AMI-CS. AMI, acute myocardial infarction; CS, cardiogenic shock; DTB, door-to-balloon; DTS, door-to-support; DTU, door-to-unload; ECMO, ExtraCorporeal Membrane Oxygenation; ECLS, Extra Corporeal Life Support; tMCS, temporary mechanical cardiac support; NSTEMI, non-ST elevation myocardial infarction; PCI, percutaneous coronary intervention; PPCI, primary percutaneous coronary intervention; R, Randomization; SOC, standard of care; STEMI, ST elevation myocardial infarction. *overall CS aetiology.

Figure 2

Time issues in AMI-CS. DTB, door-to-balloon; DTS, door-to-support; DTU, door-to-unload; LV, left ventricular; tMCS, temporary mechanical circulating support; MVD, multi-vessel disease; PCI, percutaneous coronary intervention; RV, right ventricle.