Management of cardiogenic shock complicating myocardial infarction: an update 2019

Summary

This 2019 narrative review synthesises evidence on the management of cardiogenic shock (CS) in acute myocardial infarction, a condition responsible for the majority of in-hospital deaths in this patient population. The authors report that despite widespread use of multiple therapeutic interventions—early revascularisation, vasopressors, inotropes, fluids, and mechanical circulatory support—mortality has remained largely unchanged at 40–50% over the preceding two decades. The review concludes that only revascularisation and the relative ineffectiveness of intra-aortic balloon pumping have strong evidential support, whilst other strategies lack robust evidence, highlighting a critical gap in therapeutic efficacy for this high-mortality complication.

UK applicability

This clinical review is directly applicable to UK cardiology and acute medicine practice, as cardiogenic shock management protocols in the National Health Service align with the interventions discussed. The findings regarding limited evidence for non-revascularisation strategies are relevant to UK intensive care guideline development and resource allocation in acute coronary syndrome pathways.

Key measures

Mortality rates in cardiogenic shock (40–50% range); efficacy of revascularisation, vasopressors, inotropes, fluid therapy, mechanical circulatory support, and intra-aortic balloon pumping

Outcomes reported

The review examined mortality rates and treatment efficacy for cardiogenic shock complicating acute myocardial infarction, evaluating various management strategies including revascularisation, vasopressors, inotropes, mechanical circulatory support and intensive care measures.

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