Coronary Revascularization in Cardiogenic Shock.

Abstract

Early revascularization in acute myocardial infarction (MI) complicated by cardiogenic shock (CS) reduces mortality with a life saved for every eight patients treated. Percutaneous coronary intervention (PCI) has become the mainstay of treatment for CS, particularly for ST-segment elevation MI, due to the ability to achieve rapid reperfusion; with coronary artery bypass graft (CABG) operations reserved for patients with mechanical complications or anatomy that poses challenges for timely PCI. Mortality remains high even in patients with successful revascularization, and interventional cardiologists must consider additional treatment options. Recent data supports the performance of multi-vessel PCI to achieve complete revascularization in this setting. In addition, early implementation of a percutaneous hemodynamic support device is recommended in patients in whom shock is profound and unlikely to reverse with culprit lesion PCI.