Treatment Strategies in Cardiogenic Shock Complicating Acute Myocardial Infarction

Abstract

Even though treatments of both acute myocardial infarction (MI) and congestive heart failure have improved substantially, the management of cardiogenic shock following acute MI remains a major problem. Cardiogenic shock is characterized by sustained hypotension (systolic BP <90 mm Hg), dysfunction of many organs (i.e. oliguria) and activation of the sympathetic nervous system (tachycardia, peripheral hypoperfusion). It may be seen in as many as 5–10% of patients experiencing acute MI, and in-hospital mortality often exceeds 70% despite admission to coronary centres using modern pharmacological therapy (including thrombolysis). Recent investigations suggest that early invasive revascularization, either with percutaneous transluminal coronary angioplasty or coronary bypass surgery, may substantially reduce mortality in selected groups of patients and lead to marked prognostic improvements. Consequently, the benefits of acute early invasive revascularization should be incorporated into the treatment strategy of most patients with cardiogenic shock.