Up to 10% of acute coronary syndromes are complicated by cardiogenic shock (CS) with contemporary mortality rates of 40–50%. The extent of ischemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis in this patient population. Individualized patient risk assessment plays an important role in determining appropriate revascularization, drug treatment with inotropes and vasopressors, mechanical circulatory support, intensive care support of other organ systems, hospital level of care triage, and allocation of clinical resources. This review will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of CS complicating acute coronary syndromes with a focus on (a) potential therapeutic issues from the perspective an interventional cardiologist, an emergency physician, and an intensive care physician, (b) the type of revascularization, and (c) new therapeutic advancements in pharmacologic and mechanical percutaneous circulatory support.
Bibliographical noteFunding Information:
AM received lecture fees from Novartis, Orion, and Abbott, research grants from Roche, and consultant fees from Servier and Sanofi. GL received speaker fees from Orion, Abbvie, and Tenax (companies producing or commercializing levosimendan). BL received lecture fees from Pulsion, Baxter, Orion, and Lilly, and consultant fees from Novartis, Orion, and Baxter. Other coauthors have no conflicts to declare.
- Acute myocardial infarction
- Cardiogenic shock
- Mechanical circulatory support