Rohit Mody, Department of Cardiology, Max Super specialty hospital, Bathinda, Punjab, India. Tel: +91-9888925988; E mail: drmody_2k@yahoo.com
Cardiogenic shock (CS) due to acute ST-elevation myocardial infarction is a complex state of low cardiac output and hemodynamic instability that transmutes to hypoperfusion of various body tissues leading to multi-organ dysfunction and death. Mortality rates due to CS remain high despite many recent advances in treatment. In the management of CS, early revascularization is the mainstay of the treatment. The patient can be stabilized using fluids, vasopressors or inotropes, mechanical circulatory support, and general intensive care techniques. Due to only few randomized trials on CS patients, there is a lack of concrete evidence supporting various treatment modalities, except for revascularization. Thus, CS and its management is a topic with more controversies than conclusions regarding optimal treatment and management.
Recent data suggest that mortality improvement among STelevation myocardial infarction (STEMI) has staggered in recent years [1]. CS complicates acute myocardial infarction (AMI) in approximately 10% of patients [2]. Recent registries have shown different incidences, which are decreased in some and increased in others [2]. CS caused by STEMI remains one of the most difficult conditions to manage [3]. Mortality rates are high, with up to one-half of all the patients dying before hospital discharge [4]. Timely reperfusion with a primary percutaneous intervention (PCI) is a class I recommendation in American heart association (AHA) guidelines for managing patients with STEMI complicated by CS [4]. Despite continued improvement in the door-toballoon time since the implementation of the guideline [5], mortality rates remain high. In this article, we shed light on the various approaches to manage and overcome the hurdles limiting the recovery rate of CS. At least 80% of CS cases are attributed to AMI-induced left ventricular failure (LVF). The other causes include mechanical complications of AMI, which are less frequent like ventricular septal rupture, free wall rupture, and acute severe mitral regurgitation - in less than 13% of the cases [6].