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Prognosis and treatment of cardiogenic shock complicating acute myocardial infarction

Authors
Judith S Hochman, MD
Alex Reyentovich, MD
Section Editors
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
James Hoekstra, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Cardiogenic shock (CS) is a clinical condition of inadequate tissue (end-organ) perfusion due to cardiac dysfunction. The definition includes the following hemodynamic parameters: persistent hypotension (systolic blood pressure <80 to 90 mmHg or mean arterial pressure 30 mmHg lower than baseline) with severe reduction in the cardiac index (<1.8 L/ min per m2 without support or <2 to 2.2 L/min per m2 with support) and adequate or elevated filling pressures [1]. Short-term prognosis is directly related to the severity of the hemodynamic disorder and patients most commonly succumb to multiorgan dysfunction due to ongoing organ hypoperfusion.

The most common etiology of CS is an acute myocardial infarction (usually ST elevation myocardial infarction) with left ventricular failure, but it can also be caused by mechanical complications, such as acute mitral regurgitation or rupture of either the ventricular septal or free walls. However, any cause of acute, severe left or right ventricular dysfunction may lead to CS.

The prognosis and therapy of CS complicating acute myocardial infarction (MI) will be reviewed here. The larger discussion of the causes of CS, other presentations that mimic CS secondary to MI, as well as the clinical manifestations and diagnosis of this disorder are discussed separately. (See "Clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction".)

PROGNOSIS

Temporal trends — The incidence of cardiogenic shock (CS) appears to be falling since the mid 1970s. In a report from one United States metropolitan area (Worcester, Massachusetts), the incidence of CS was around 7 percent between 1975 and 1990 and has decreased to between 5.5 to 6.0 percent since then [2].

The historic mortality rate for CS complicating an acute myocardial infarction (MI) was 80 to 90 percent [3]. However, lower values for in-hospital mortality have been noted in more studies, ranging from 48 to 74 percent [4-9]. Studies have suggested short-term mortality rates between 42 and 48 percent [2,9,10].

                                                

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Literature review current through: Nov 2016. | This topic last updated: Wed Apr 29 00:00:00 GMT+00:00 2015.
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