Update in the Management of Acute Coronary Syndrome Patients with Cardiogenic Shock

  • Jayant Bagai
  • Emmanouil S. BrilakisEmail author
Management of Acute Coronary Syndromes (H Jneid, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Management of Acute Coronary Syndromes


Purpose of Review

We provide a concise update on the contemporary management of cardiogenic shock in the setting of acute coronary syndrome (ACS). Early shock recognition, optimal selection and initiation of mechanical circulatory support (MCS), early coronary revascularization, and a team-based, protocol-driven approach are the current pillars of management.

Recent Findings

Cardiogenic shock complicates approximately 5–10% of ACS cases and continues to have high mortality. Early use of mechanical circulatory may prevent the downward spiral of shock and has significantly increased over time, supported mainly by registry data. In the CULPRIT-SHOCK trial, culprit-only revascularization was associated with a lower 30-day incidence of all-cause death or severe renal failure, compared with immediate multivessel PCI. Routine revascularization of non-infarct related artery lesion(s) during primary PCI for cardiogenic shock is, therefore, not recommended. The routine use of an intra-aortic balloon pump (IABP) was not associated with improved outcomes in the IABP-SHOCK II trial. A team-based and protocol-driven approach may further improve outcomes.


Recent advances in coronary revascularization and use of MCS, implementation of shock teams and standardized protocols may improve outcomes of cardiogenic shock in ACS patients.


Cardiogenic shock Acute coronary syndrome Acute myocardial infarction Mechanical circulatory support Update 



Acute coronary syndrome


Acute myocardial infarction complicated with cardiogenic shock


Coronary artery disease


Cardiac power output


Cardiogenic shock


Chronic total occlusion


Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock


Catheter-based ventricular assist device


Central venous pressure


Extracorporeal cardiopulmonary resuscitation


Intra-aortic balloon pump


Intra-aortic Balloon Pump in Cardiogenic Shock II


Impella versus IABP Reduces mortality in STEMI patients treated with primary PCI in severe cardiogenic SHOCK


Mechanical circulatory support


Acute myocardial infarction


Pulmonary Artery Pulsatility Index


Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome


Right ventricular


Systolic blood pressure


Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock


ST segment elevation acute myocardial infarction


Veno-arterial extracorporeal membrane oxygenation


Compliance with Ethical Standards

Conflict of Interest

Jayant Bagai declares no conflict of interest.

Emmanouil S. Brilakis reports the following: Consulting/speaker honoraria from Abbott Vascular, American Heart Association (Associate Editor, Circulation), Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, InfraRedx, and Medtronic. Research support from Siemens, and Regeneron, Shareholder: MHI Ventures. Board of Trustees: Society of Cardiovascular Angiography and Interventions.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Vanderbilt University Medical CenterNashvilleUSA
  2. 2.Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute FoundationMinneapolisUSA

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