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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)
  • 231 Downloads
Part of the following topical collections:
  1. Topical Collection on Management of Acute Coronary Syndromes

Abstract

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.

Summary

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.

Keywords

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

Abbreviations

ACS

Acute coronary syndrome

AMICS

Acute myocardial infarction complicated with cardiogenic shock

CAD

Coronary artery disease

CPO

Cardiac power output

CS

Cardiogenic shock

CTO

Chronic total occlusion

CULPRIT-SHOCK

Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock

cVAD

Catheter-based ventricular assist device

CVP

Central venous pressure

e-CPR

Extracorporeal cardiopulmonary resuscitation

IABP

Intra-aortic balloon pump

IABP-SHOCK II

Intra-aortic Balloon Pump in Cardiogenic Shock II

IMPRESS

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

MCS

Mechanical circulatory support

AMI

Acute myocardial infarction

PAPi

Pulmonary Artery Pulsatility Index

RIFLE-STEACS

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

RV

Right ventricular

SBP

Systolic blood pressure

SHOCK

Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock

STEMI

ST segment elevation acute myocardial infarction

VA-ECMO

Veno-arterial extracorporeal membrane oxygenation

Notes

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.

References

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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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