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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

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Cardiogenic shock: role of invasive cardiology

Hans-Josef Feistritzer1, Holger Thiele, Steffen Desch

  • 1Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.

Current Opinion in Critical Care
|May 27, 2020
PubMed

Insights

Early revascularization improves outcomes for acute myocardial infarction (AMI) patients with cardiogenic shock. Treatment should focus on the culprit lesion, though mortality remains high, necessitating further research into optimal strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Myocardial Infarction

Background:

  • Cardiogenic shock following acute myocardial infarction (AMI) carries a substantial mortality rate (40-50% at 30 days).
  • Early revascularization is a critical intervention for improving outcomes in these patients.

Purpose of the Study:

  • To review current evidence on revascularization strategies for infarct-related cardiogenic shock.
  • To summarize data on vascular access sites and antiplatelet/antithrombotic therapies in this context.

Main Methods:

  • Review of existing clinical trials and evidence.
  • Focus on findings from the SHOCK and CULPRIT-SHOCK trials.
  • Discussion of current and ongoing randomized trials.

Main Results:

  • Early revascularization, particularly percutaneous coronary intervention (PCI) to the culprit lesion, is recommended.
  • Multivessel coronary disease is common in patients with infarct-related cardiogenic shock.
  • Data on vascular access sites in cardiogenic shock are limited; emergency coronary artery bypass grafting (CABG) is rarely used but remains an option for non-PCI-amenable anatomy.

Conclusions:

  • Confining emergency revascularization to the culprit lesion is the current standard of care.
  • Ongoing research is evaluating novel antiplatelet therapies for infarct-related cardiogenic shock.
Abstract

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