Management of cardiogenic shock complicating myocardial infarction

Alexandre Mebazaa, Alain Combes, Sean van Diepen, Alexa Hollinger, Jaon N. Katz, Giovanni Landoni, Ludhmila Abrahao Hajjar, Johan Lassus, Guillaume Lebreton, Gilles Montalescot, Jin Joo Park, Susanna Price, Alessandro Sionis, Demetris Yannopolos, Veli Pekka Harjola, Bruno Levy, Holger Thiele

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)760-773
Number of pages14
JournalIntensive Care Medicine
Volume44
Issue number6
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

Bibliographical note

Funding 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.

Keywords

  • Acute myocardial infarction
  • Cardiogenic shock
  • Catecholamines
  • Mechanical circulatory support

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