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Cardiogenic shock

M Moscucci1, E R Bates

  • 1Division of Cardiology, University of Michigan, Ann Arbor, USA.

Cardiology Clinics
|August 1, 1995
PubMed
Summary
This summary is machine-generated.

Cardiogenic shock following myocardial infarction has high mortality. Emergency revascularization, specifically percutaneous transluminal coronary angioplasty (PTCA), is being investigated in ongoing trials to improve outcomes.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Critical Care Medicine

Background:

  • In-hospital mortality for cardiogenic shock remains high (70-80%) despite medical and mechanical support.
  • Thrombolytic therapy benefits in acute myocardial infarction do not extend to cardiogenic shock.
  • Emergency revascularization is a potential intervention for improving cardiogenic shock prognosis.

Purpose of the Study:

  • To evaluate the efficacy of emergency revascularization in patients with cardiogenic shock.
  • To determine if percutaneous transluminal coronary angioplasty (PTCA) improves survival in cardiogenic shock.
  • To identify patient subsets most likely to benefit from PTCA.

Main Methods:

  • Two ongoing randomized clinical trials: the multicenter international SHOCK trial and the Swiss Multicenter Study of Angioplasty for Shock (SMASH) trial.

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  • Patients are randomized to PTCA or conservative treatment.
  • Mortality is the primary end point in both trials.

    • Main Results:

    • Controlled data on the efficacy of emergency revascularization in cardiogenic shock is currently lacking.
    • Ongoing trials (SHOCK and SMASH) aim to provide definitive evidence.
    • Results from these trials are anticipated to clarify the role of PTCA.

    Conclusions:

    • Emergency revascularization, particularly PTCA, holds promise for improving cardiogenic shock outcomes.
    • Further evidence from randomized trials is needed to confirm the benefits of PTCA.
    • Identifying specific patient groups who benefit most from PTCA is a key objective.