Optimal course of treatment in acute cardiogenic shock complicating myocardial infarction

ABSTRACT

Introduction: About 5% of patients with myocardial infarction suffer from cardiogenic shock as a complication, with a mortality of ≥30%. Primary percutaneous coronary intervention as soon as possible is the most successful therapeutic approach. Prognosis depends not only on the extent of infarction, but also – and even more – on organ hypoperfusion with consequent development of multiple organ dysfunction syndrome.

Areas covered: This review covers diagnostic, monitoring and treatment concepts relevant for caring patients with cardiogenic shock complicating myocardial infarction. All major clinical trials have been selected for review of the recent data.

Expert commentary: For optimal care, not only primary percutaneous intervention of the occluded coronary artery is necessary, but also best intensive care medicine avoiding the development of multiple organ dysfunction syndrome and finally death. On contrary, intra-aortic balloon pump – though used for decades – is unable to reduce mortality of patients with cardiogenic shock complicating myocardial infarction.

KEYWORDS:

• Acute heart failure
• cardiogenic shock
• IABP
• IABP-SHOCK trial
• IABP-SHOCK II trial
• multiple organ dysfunction syndrome
• myocardial infarction
• percutaneous coronary intervention
• mechanical cardiac support

Acknowledgments

The authors gratefully acknowledge stimulating discussions with members of the TEMPHUS project team FKZ: I3GW0034B (J. Schröder, T. Otto, and L. Thieme).

Declaration of interest

S Nuding and K Werdan are engaged in the TEMPHUS project about temporary mechanical support which is sponsored by the German Federal Ministry of Education and Research (BMBF, FKZ: 13GW0034B). The BMBF supported the TEMPHUS project by funding personnel expenses for theoretical-scientific research in the field of cardiac dysfunction and critical illness. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental Material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the German Federal ministry of Education and Research (BMBF) [grant number 13GW0034B].