Back to the Future in Cardiogenic Shock — Initial PCI of the Culprit Lesion Only

Abstract

Approximately 5 to 10% of cases of acute myocardial infarction are complicated by cardiogenic shock, which is associated with early mortality of 40 to 50%.1 Nearly two decades ago, the SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial established that mortality was lower with emergency revascularization than with initial medical stabilization and selective delayed revascularization in patients with ST-segment elevation myocardial infarction (STEMI).2,3 In the SHOCK trial, percutaneous coronary intervention (PCI) of the culprit lesion only was the most common therapy for initial revascularization. Although more complete revascularization might have been expected to have an increased benefit, .