Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock.

Ahmed Abdalwahab,Azfar Zaman,Mohaned Egred,Mohammad Alkhalil,Amjad Ghazal Asswad,Ayman Al-Atta,Mohammad Zaidan

doi:10.31083/j.rcm2302071

Abstract

Patients with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) have poor prognosis. Over the last two decades, there has been some improvement in mortality rates associated with CS. Initial measures to stabilise patients should follow a shock protocol, including therapies such as volume expansion, inotropes/vasopressors, and early coronary revascularisation. The use of mechanical circulatory support (MCS) devices demonstrated better haemodynamic and metabolic profiles for patients with CS. However, these benefits have not been consistently translated into significant reductions in cardiovascular adverse events. This review aims to discuss emerging concepts related to CS including an update on its classification and pathophysiology. The focus is on recent evidence regarding the use of MCS and the timing of initiating in patients with CS.

Highlights

Cardiogenic shock (CS) is a direct consequence of low cardiac output state leading to circulatory failure and hypoperfusion
This becomes more important since the primary endpoint was the composite of death and severe renal failure leading to renal replacement therapy which occurred in 46% in the culprit lesion-only group compared to 55.4% in the multivessel percutaneous coronary intervention (PCI) [10]
The development of a shock protocol alongside better understanding of the pathophysiology of CS and optimal patient selection may help reducing mortality associated with CS

Summary

Introduction

Cardiogenic shock (CS) is a direct consequence of low cardiac output state leading to circulatory failure and hypoperfusion. It can result from impairment of either left or right ventricle function and may occur as an acute ischaemic or non-ischaemic event or due to progression in longstanding disease affecting the myocardium [1]. Over the last two decades, there has been some improvement in the in-hospital mortality rate related to CS. Such improvement is likely to be multifactorial. Recognition of CS, better triage, use of invasive haemodynamic monitoring and development of mechanical circulatory support (MCS) may have contributed to the decline in mortality [5]. This review article discusses the pathophysiology and contemporary management of CS with focus on contemporary MCS devices

Objectives

Methods

Findings

Conclusion