[Cardiogenic shock : Current evidence]

Area of Science:

• Cardiology
• Critical Care Medicine

Background:

• Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI).
• CS involves a complex pathophysiology including left heart failure, vasoconstriction, and systemic inflammation response syndrome (SIRS).
• Understanding the shock spiral is crucial for effective intervention.

Purpose of the Study:

• To review the pathophysiology, incidence, survival outcomes, and treatment options for CS post-AMI.
• To synthesize evidence from randomized clinical trials and guideline recommendations for managing CS.
• To address unresolved questions in interventional and surgical treatment strategies.

Main Methods:

• Review of randomized clinical trials (RCTs) and current guideline recommendations.
• Analysis of evidence for medical, interventional, and surgical treatment options.
• Evaluation of circulatory support devices.

Main Results:

• Acetylsalicylic acid (ASA) and heparin are often combined with prasugrel and ticagrelor.
• Dobutamine is the first-line inotrope; norepinephrine is the preferred vasopressor.
• Levosimendan did not demonstrate superiority over conventional treatments in RCTs.
• Intra-aortic balloon pumps (IABP) are no longer recommended for acute heart failure (Class III).
• Percutaneous mechanical circulatory support devices have not shown survival benefits compared to IABP due to bleeding complications.

Conclusions:

• Interrupting the cardiogenic shock spiral is a primary treatment goal.
• Treatment decisions should be guided by RCT evidence and current guidelines.
• Complete revascularization versus culprit lesion-only revascularization remains an area of investigation.
• Current evidence does not support routine use of IABP or percutaneous mechanical circulatory support for improved survival in CS post-AMI.