Cardiogenic Shock After Acute Myocardial Infarction

Abstract

ardiogenic shock (CS) is defined by systemic hypoperfusion and tissue hypoxia due to cardiac dysfunction. The most common etiology of CS is acute myocardial ischemia due to occlusion of an epicardial coronary artery, resulting in regional cardiac myocyte necrosis (acute myocardial infarction [AMI]) and loss of ventricular function. 1 CS is the leading cause of in-hospital death in patients with AMI. Between 40 000 and 50 000 patients in the US have CS associated with AMI each year, which correlates to an incidence of approximately 5% to 10% of all patients with AMI. [2][3][4][5] Thirty-day mortality is nearly 40% and approaches approximately 50% at 1 year (Box). [5][6][7][8] Severe left ventricular (LV) dysfunction is the most common presentation of CS in the setting of AMI, most frequently occurring after anterior MI. Of the 686 patients included in the Percutaneous Coronary Intervention Strategies with Acute Myocardial Infarction and Cardiogenic Shock (CULPRIT-SHOCK) trial, 288 (42.0%) had a left anterior descending MI and 53 (7.7%) had a left main coronary artery MI. 7 Few treatment approaches reduce short-or long-term morbidity and mortality in patients with CS. This review describes the pathophysiology, diagnosis, and management of CS in the setting of AMI. MethodsA literature search was performed that applied the Cochrane Highly Sensitive Search Strategy for randomized clinical trials (RCTs), a string for meta-analyses and systematic reviews, and established Medical Subject Headings for "cardiogenic shock" and "treatment" to the PubMed and Cochrane databases for articles published from January 1, 1995, through August 5, 2021. The literature search identified 1552 articles. The authors prioritized RCTs, meta-analyses, and larger observational studies. A total of 46 papers were included, including 12 randomized trials, 2 metaanalyses, 1 systematic review, and 31 observational studies.

Association Between Triglyceride Glucose Index-Waist Circumference and Risk of First Myocardial Infarction in Chinese Hypertensive Patients with Obstructive Sleep Apnoea: An Observational Cohort Study

“… 1 In the United States alone, more than 1,000,000 people suffer from MI each year. 2 The Global Registry of Acute Coronary Events (GRACE) study showed that patients with MI have a mortality rate of approximately 15% after 1 year and a cumulative mortality rate of up to 20% after 5 years. 3 Therefore, a better understanding of the risk factors for MI is needed to develop additional preventive strategies.…”

When to Achieve Complete Revascularization in Infarct-Related Cardiogenic Shock

“…Moreover, among patients who developed CS, those without ST-segment elevation had more frequently several adverse baseline characteristics than those with ST-segment elevation, such as significantly older age, and a greater frequency of prior infarction, multivessel disease and congestive heart failure [ 29 , 30 , 31 ].…”

Blood urea nitrogen to creatinine ratio is associated with in-hospital mortality among critically ill patients with cardiogenic shock

“…The prevalence of CS in the ICU/ICCU dataset is 14–16% [ 5 ]. In-hospital mortality rates range from 30 to 60%, with nearly half of in-hospital deaths occurring within 24 h of onset, 70–80% of deaths occur 30–60 days after CS onset, indicating that the risk of death is time-dependent and clustered early after onset [ 6 ]. Therefore, early identification of high-risk CS patients is essential.…”