Abstract
Acute myocardial infarction with cardiogenic shock (AMI-CS) is associated with high mortality and morbidity despite advancements in cardiovascular care. AMI-CS is associated with multiorgan failure of non-cardiac organ systems. Acute kidney injury (AKI) is frequently seen in patients with AMI-CS and is associated with worse mortality and outcomes compared to those without. The pathogenesis of AMI-CS associated with AKI may involve more factors than previously understood. Early use of renal replacement therapies, management of comorbid conditions and judicious fluid administration may help improve outcomes. In this review, we seek to address the etiology, pathophysiology, management, and outcomes of AKI complicating AMI-CS.
Highlights
Despite advances in medical therapy, cardiogenic shock (CS), continues to portend a poor prognosis
It is noteworthy that 49.5% of these patients were treated with mechanical circulatory support (MCS) such as intra-aortic balloon pump (IABP) (42.1% in 2003 and 36.1% in 2015), percutaneous ventricular assist devices (0% in 2003 to 7.6% in 2015) and extracorporeal membrane oxygenation (ECMO) (0.5% in 2003 to 8.4% in 2015) [11]
Hanberg et al demonstrated that overall cardiac index (CI) or change in CI leading to organ hypoperfusion is not the primary driver for renal dysfunction in patients hospitalized for heart failure (HF)
Summary
Despite advances in medical therapy, cardiogenic shock (CS), continues to portend a poor prognosis. Cardiogenic shock, especially related to acute myocardial infarction (AMI), is associated with a nearly 50% in-hospital mortality and a high rate of readmissions for cardiac and non-cardiac reasons [1]. In addition to cardiac etiologies for decompensation, non-cardiac organ failure plays an important factor in determining outcomes [1,2,3]. Increase in creatinine from baseline value) as per The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, is frequently seen in CS, and strongly associated with increased mortality [5]. ST-elevated myocardial infarction (STEMI) complicated by CS and associated with a poor prognosis [6]. We seek to address the etiology, pathophysiology, management, and outcomes of AKI complicating AMI-CS
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