Medical Treatment for Cardiogenic Shock

Abstract

Cardiogenic shock occurs in 7–10% of patients with acute myocardial infarction and is usually associated with extensive infarction of the left ventricle. It has remained the leading cause of death among patients hospitalized for acute myocardial infarction in the reperfusion era (1,2), although changes in treatment in recent years have reduced the mortality rate. For instance, the long-term Worcester Heart Attack Study of patients from all hospitals in Worcester, Massachusetts reported that the mortality rate from cardiogenic shock (defined throughout as a systolic blood pressure of <80 mm Hg and evidence of end-organ hypoperfusion in the absence of hypovolemia) fell from an average of 77% prior to 1993 to approx 60% in 1993–1997, whereas the use of revascularization procedures increased from 10% to 42%, intra-aortic balloon pump counterpulsation (IABP) from 16% to 42%, and thrombolytic therapy from 8% (in 1986–1988) to 25% (Fig. 1) (3). The report did not, however, elaborate on what changes may have occurred since 1975 in the timing of therapies relative to the onset of shock.