Leczenie wstrząsu kardiogennego wikłającego zawał serca — nadal więcej pytań niż jednoznacznych odpowiedzi

Abstract

Cardiogenic shock is usually caused by a severe myocardium injury resulting in stroke volume and cardiac output decrease. As a consequence, hypotension and coronary and peripherial hypoperfusion may occur. The mortality in patients with cardiogenic shock is high, and exceeds 40%. Despite the advances in intervention cardiology in the last 20 years, no significant mortality reduction has been observed. Although urgent coronary revascularisation is considered to play a pivotal role in survival improvement in patients with cardiogenic shock, there is no consuensus in terms of revascularisation strategy, including primary coronary angioplasty ( i.e. complete revascularisation vs. revascularisation limited to the infarct-related artery). Current guidelines do not recommend routine use of an intra-aortic balloon pump in patients with CS. However, such a simple and widely available therapy may improve the survival rate in some groups of patients. This is particularly important because there is as yet no evidence for survival improvement in patients with CS treated with more advanced methods of percutaneous mechanical circulatory support, not to mention the limited availability of these methods in everyday clinical practice.