Trends in Management and Outcomes of Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

Abstract

Cardiogenic shock remains the leading cause of death in patients hospitalized with acute myocardial infarction (AMI).¹ The SHOCK randomized trial^2,3 demonstrated that in patients with AMI complicated by cardiogenic shock, early mechanical revascularization reduced 6- and 12-month mortality compared with initial medical stabilization (including intra-aortic balloon pump [IABP] counterpulsation and fibrinolytic therapy) followed by late or no revascularization. There was a significant interaction between treatment and age, with apparent lack of benefit of early revascularization for the small subset of patients aged 75 years or older.^2,3 Based on these findings, the American College of Cardiology (ACC) and the American Heart Association (AHA) elevated early mechanical revascularization for cardiogenic shock to a class I recommendation for patients younger than 75 years with ST-elevation left bundle-branch block AMI in their revised guidelines for the management of AMI published in September 1999.⁴