Abstract
Cardiogenic shock (CS) is a hemodynamically complex and highly morbid syndrome characterized by circulatory collapse and inadequate end-organ perfusion due to impaired cardiac output. It is usually associated with multiorgan failure and death. Mortality rate is still high despite advancement in treatment. CS has been conceptualised as a vicious cycle of injury and decompensation, both cardiac and systemic. Interrupting the vicious cycle and restoring the hemodynamic stability is a fundamental treatment of CS. Acute coronary syndrome (ACS) is the most frequent cause of CS. Early coronary revascularization is a cornerstone therapy that reduces mortality in patients with ACS complicated by CS. Early diagnosis of CS accompanied with invasive hemodynamics, helps in identification of CS phenotype, classification of CS severity, stratification of risk and prognostication. This can guide a tailored and optimized therapeutic approach. Inotropes and vasopressors are considered the first-line pharmacological option for hemodynamic instability. The current availability of the mechanical circulatory support devices has broadened the therapeutic choices for hemodynamic support. To date there is no pharmacological or nonpharmacological intervention for CS that showed a mortality benefit. The clinical practices in CS management remain inconsistent. Herein, this review discusses the current evidence in the diagnosis and management of CS complicating ACS, and features the changes in CS definition and classification.
Highlights
Shock in the general term is a circulatory failure due to impaired oxygen utilization by the body cells, which affects approximately one third of critically ill patients
When the Society for Cardiovascular Angiography and Interventions (SCAI) classification was retrospectively applied to patients presenting with acute myocardial infarction (MI) and Cardiogenic shock (CS) (n = 300) in the National Cardiogenic Shock Initiative, the analysis demonstrated that such classification was reproducible and provided prognostic guidance among this subset of patients when applied on admission and at 24 hours after admission
The analysis showed that PAC use was associated with increased use of mechanical ventilation, vasoactive agents, mechanical circulatory support (MCS) devices, and renal replacement therapy, but not with 30-day mortality [83]
Summary
Shock in the general term is a circulatory failure due to impaired oxygen utilization by the body cells, which affects approximately one third of critically ill patients. The distributive shock is usually characterized by high cardiac output (CO), reduced systemic vascular resistance (SVR), and altered oxygen extraction. Acute coronary syndrome (ACS) is the most common cause of CS, accounting for up to 80% of the cases [5]. CS complicates 4–12% of ST-segment elevation myocardial infarction (STEMI) [2, 3, 6,7,8] and 2–4% of non-STEMI patients [2, 7,8,9,10]. Early mortality due to CS complicating acute MI remains high, in up to 50% of patients [5, 6, 13, 19, 20], even after more than 20 years of the SHOCK trial publication [21].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
