Revascularisation and mechanical circulatory support in patients with ischaemic cardiogenic shock

Learning objectives

  • Revascularisation strategies in cardiogenic shock.

  • Mechanical circulatory support in cardiogenic shock.

  • Evidence base to guide current best practice.

  • Introduction

    Cardiogenic shock (CGS) complicates 5 – 10% of cases of acute myocardial infarction (AMI) and the most common cause of CGS is AMI (80% of cases).1 When CGS occurs after ST-segment elevation myocardial infarction (STEMI), the median time delay before the onset of shock is 5–6 hours.2 CGS complicates non-ST-segment elevation myocardial infarction (NSTEMI) less frequently (approximately 2.5% of NSTEMI cases) and tends to occur later (median time delay of 76 hours).3 Fewer than 50% of patients with CGS survive up to 1 year.4

    The clinical syndrome of CGS is present when there is inadequate cardiac output and systemic tissue hypoperfusion despite adequate circulating volume and filling pressure. The haemodynamic criteria used to define CGS are a systolic blood…

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