Skip to main content
Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin 4/2018

02.05.2018 | ST-Hebungsinfarkt | Leitthema

Infarktbedingter kardiogener Schock

Prognose und Behandlung

verfasst von: PD Dr. R. Prondzinsky, H. Lemm, A. Geppert, M. Buerke, M. Russ, K. Werdan

Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Zusammenfassung

Patienten mit ST-Strecken-Hebungs-Infarkt (STEMI) und Nicht-ST-Strecken-Hebungs-Infarkt (NSTEMI) erleiden in etwa 6–10 % der Fälle im Krankenhaus einem kardiogenen Schock. In den letzten Jahren scheint sich die Inzidenz aufgrund der invasiven Diagnostik und Therapie nach Myokardinfarkt zu reduzieren. Wichtig ist die frühzeitige Diagnose und die umgehende Einleitung einer Revaskularisation mittels perkutaner koronarer Intervention (PCI) und Stent im Rahmen des kardiogenen Schocks. So kann eine deutliche Verbesserung des Überlebens erreicht werden. Pharmakologische und mechanische Unterstützung sind notwendig, um die Perfusion des Myokards und der Organe aufrecht zu erhalten. Als medikamentöse Therapie bei infarktbedingtem kardiogenem Schock haben sich Dobutamin als Inotropikum und Noradrenalin als Vasopressor etabliert. Zur weiteren Unterstützung liegen Daten zu Levosimendan vor. Die pharmakologische Therapie wird durch mechanische Unterstützungssysteme, wie Impella (ABIOMED, Danvers, MA, USA) oder extrakorporale Membranoxygenierung (ECMO), ergänzt. Die intraaortale Ballonpumpe (IABP) spielt kaum noch eine Rolle. Die Mehrzahl der Überlebenden des kardiogenen Schocks haben langfristig nur eine geringe funktionelle kardiale Einschränkung. Dies zeigt die passagere Schädigungskomponente („stunning“, Inflammation), was die Notwendigkeit einer schnellen kreislaufunterstützenden Therapie unterstreicht.
Literatur
1.
Zurück zum Zitat Reynolds HR, Hochman JS (2008) Cardiogenic shock: current concepts and improving outcomes. Circulation 117:686CrossRefPubMed Reynolds HR, Hochman JS (2008) Cardiogenic shock: current concepts and improving outcomes. Circulation 117:686CrossRefPubMed
2.
Zurück zum Zitat Goldberg RJ, Spencer FA, Gore JM et al (2009) Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation 119:1211CrossRefPubMedPubMedCentral Goldberg RJ, Spencer FA, Gore JM et al (2009) Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation 119:1211CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Goldberg RJ, Gore JM, Alpert JS et al (1991) Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988. N Engl J Med 325:1117CrossRefPubMed Goldberg RJ, Gore JM, Alpert JS et al (1991) Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988. N Engl J Med 325:1117CrossRefPubMed
4.
Zurück zum Zitat Hochman JS, Boland J, Sleeper LA et al (1995) Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an international registry. SHOCK registry investigators. Circulation 91:873CrossRefPubMed Hochman JS, Boland J, Sleeper LA et al (1995) Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an international registry. SHOCK registry investigators. Circulation 91:873CrossRefPubMed
5.
Zurück zum Zitat Goldberg RJ, Gore JM, Thompson CA, Gurwitz JH (2001) Recent magnitude of and temporal trends (1994–1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: the second national registry of myocardial infarction. Am Heart J 141:65CrossRefPubMed Goldberg RJ, Gore JM, Thompson CA, Gurwitz JH (2001) Recent magnitude of and temporal trends (1994–1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: the second national registry of myocardial infarction. Am Heart J 141:65CrossRefPubMed
6.
Zurück zum Zitat Holmes DR Jr, Bates ER, Kleiman NS et al (1995) Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I investigators. Global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries. J Am Coll Cardiol 26:668CrossRefPubMed Holmes DR Jr, Bates ER, Kleiman NS et al (1995) Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I investigators. Global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries. J Am Coll Cardiol 26:668CrossRefPubMed
7.
Zurück zum Zitat Goldberg RJ, Samad NA, Yarzebski J et al (1999) Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 340:1162CrossRefPubMed Goldberg RJ, Samad NA, Yarzebski J et al (1999) Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 340:1162CrossRefPubMed
8.
Zurück zum Zitat Holmes DR Jr, Berger PB, Hochman JS et al (1999) Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation 100:2067CrossRefPubMed Holmes DR Jr, Berger PB, Hochman JS et al (1999) Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation 100:2067CrossRefPubMed
9.
Zurück zum Zitat Babaev A, Frederick PD, Pasta DJ et al (2005) Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 294:448CrossRefPubMed Babaev A, Frederick PD, Pasta DJ et al (2005) Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 294:448CrossRefPubMed
10.
Zurück zum Zitat Hasdai D, Holmes DR Jr, Califf RM et al (1999) Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO investigators. Global utilization of streptokinase and tissue-plasminogen activator for occluded coronary arteries. Am Heart J 138:21CrossRefPubMed Hasdai D, Holmes DR Jr, Califf RM et al (1999) Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO investigators. Global utilization of streptokinase and tissue-plasminogen activator for occluded coronary arteries. Am Heart J 138:21CrossRefPubMed
11.
Zurück zum Zitat Fincke R, Hochman JS, Lowe AM et al (2004) Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry. J Am Coll Cardiol 44:340CrossRefPubMed Fincke R, Hochman JS, Lowe AM et al (2004) Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry. J Am Coll Cardiol 44:340CrossRefPubMed
12.
Zurück zum Zitat Wong SC, Sanborn T, Sleeper LA et al (2000) Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shocK? J Am Coll Cardiol 36:1077CrossRefPubMed Wong SC, Sanborn T, Sleeper LA et al (2000) Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shocK? J Am Coll Cardiol 36:1077CrossRefPubMed
13.
Zurück zum Zitat Sanborn TA, Sleeper LA, Webb JG et al (2003) Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. J Am Coll Cardiol 42:1373CrossRefPubMed Sanborn TA, Sleeper LA, Webb JG et al (2003) Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. J Am Coll Cardiol 42:1373CrossRefPubMed
14.
Zurück zum Zitat Picard MH, Davidoff R, Sleeper LA et al (2003) Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. Circulation 107:279CrossRefPubMed Picard MH, Davidoff R, Sleeper LA et al (2003) Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. Circulation 107:279CrossRefPubMed
15.
Zurück zum Zitat Ortolani P, Marzocchi A, Marrozzini C et al (2006) Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction. Eur Heart J 27:1550CrossRefPubMed Ortolani P, Marzocchi A, Marrozzini C et al (2006) Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction. Eur Heart J 27:1550CrossRefPubMed
16.
Zurück zum Zitat Hochman JS, Sleeper LA, Webb JG et al (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341:625CrossRefPubMed Hochman JS, Sleeper LA, Webb JG et al (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341:625CrossRefPubMed
17.
Zurück zum Zitat Ramanathan K, Farkouh ME, Cosmi JE et al (2011) Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction. Am Heart J 162:268CrossRefPubMedPubMedCentral Ramanathan K, Farkouh ME, Cosmi JE et al (2011) Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction. Am Heart J 162:268CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Hasdai D, Harrington RA, Hochman JS et al (2000) Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation. J Am Coll Cardiol 36:685CrossRefPubMed Hasdai D, Harrington RA, Hochman JS et al (2000) Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation. J Am Coll Cardiol 36:685CrossRefPubMed
20.
Zurück zum Zitat Bonello L, De Labriolle A, Roy P et al (2008) Bivalirudin with provisional glycoprotein IIb/IIIa inhibitors in patients undergoing primary angioplasty in the setting of cardiogenic shock. Am J Cardiol 102:287CrossRefPubMed Bonello L, De Labriolle A, Roy P et al (2008) Bivalirudin with provisional glycoprotein IIb/IIIa inhibitors in patients undergoing primary angioplasty in the setting of cardiogenic shock. Am J Cardiol 102:287CrossRefPubMed
21.
Zurück zum Zitat TRIUMPH Investigators, Alexander JH, Reynolds HR et al (2007) Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA 297:1657CrossRef TRIUMPH Investigators, Alexander JH, Reynolds HR et al (2007) Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA 297:1657CrossRef
22.
Zurück zum Zitat Mueller HS, Chatterjee K, Davis KB et al (1998) ACC expert consensus document. Present use of bedside right heart catheterization in patients with cardiac disease. American College of Cardiology. J Am Coll Cardiol 32:840CrossRefPubMed Mueller HS, Chatterjee K, Davis KB et al (1998) ACC expert consensus document. Present use of bedside right heart catheterization in patients with cardiac disease. American College of Cardiology. J Am Coll Cardiol 32:840CrossRefPubMed
24.
Zurück zum Zitat Menon V, White H, LeJemtel T et al (2000) The clinical profile of patients with suspected cardiogenic shock due to predominant left ventricular failure: a report from the SHOCK trial registry. Should we emergently revascularize occluded coronaries in cardiogenic shocK? J Am Coll Cardiol 36:1071CrossRefPubMed Menon V, White H, LeJemtel T et al (2000) The clinical profile of patients with suspected cardiogenic shock due to predominant left ventricular failure: a report from the SHOCK trial registry. Should we emergently revascularize occluded coronaries in cardiogenic shocK? J Am Coll Cardiol 36:1071CrossRefPubMed
25.
26.
Zurück zum Zitat Prondzinsky R, Lemm H, Swyter M, Wegener N, Unverzagt S, Carter JM, Russ M, Schlitt A, Buerke U, Christoph A, Schmidt H, Winkler M, Thiery J, Werdan K, Buerke M (2010) Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP SHOCK Trial for attenuation of multiorgan dysfunction syndrome. Crit Care Med 38(1):152–160CrossRefPubMed Prondzinsky R, Lemm H, Swyter M, Wegener N, Unverzagt S, Carter JM, Russ M, Schlitt A, Buerke U, Christoph A, Schmidt H, Winkler M, Thiery J, Werdan K, Buerke M (2010) Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP SHOCK Trial for attenuation of multiorgan dysfunction syndrome. Crit Care Med 38(1):152–160CrossRefPubMed
27.
Zurück zum Zitat Prondzinsky R, Unverzagt S, Russ M, Lemm H, Swyter M, Wegener N, Buerke U, Raaz U, Ebelt H, Schlitt A, Heinroth K, Haerting J, Werdan K, Buerke M (2012) Hemodynamic effects of intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP shock trial. Shock 37(4):378–384CrossRefPubMed Prondzinsky R, Unverzagt S, Russ M, Lemm H, Swyter M, Wegener N, Buerke U, Raaz U, Ebelt H, Schlitt A, Heinroth K, Haerting J, Werdan K, Buerke M (2012) Hemodynamic effects of intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP shock trial. Shock 37(4):378–384CrossRefPubMed
28.
Zurück zum Zitat Thiele H, Zeymer U, Neumann FJ et al (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287CrossRefPubMed Thiele H, Zeymer U, Neumann FJ et al (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287CrossRefPubMed
30.
Zurück zum Zitat Lauten A, Engström AE, Jung C et al (2013) Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry. Circ Heart Fail 6:23CrossRefPubMed Lauten A, Engström AE, Jung C et al (2013) Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry. Circ Heart Fail 6:23CrossRefPubMed
31.
Zurück zum Zitat Roffi M, Patrono C, Collet JP et al (2016) 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 37:267CrossRefPubMed Roffi M, Patrono C, Collet JP et al (2016) 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 37:267CrossRefPubMed
32.
Zurück zum Zitat Thiele H, Sick P, Boudriot E et al (2005) Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 26:1276CrossRefPubMed Thiele H, Sick P, Boudriot E et al (2005) Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 26:1276CrossRefPubMed
33.
Zurück zum Zitat Seyfarth M, Sibbing D, Bauer I et al (2008) A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol 52:1584CrossRefPubMed Seyfarth M, Sibbing D, Bauer I et al (2008) A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol 52:1584CrossRefPubMed
34.
Zurück zum Zitat Zeymer U, Vogt A, Zahn R et al (2004) Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Eur Heart J 25:322CrossRefPubMed Zeymer U, Vogt A, Zahn R et al (2004) Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Eur Heart J 25:322CrossRefPubMed
35.
Zurück zum Zitat Bengtson JR, Kaplan AJ, Pieper KS et al (1992) Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era. J Am Coll Cardiol 20:1482CrossRefPubMed Bengtson JR, Kaplan AJ, Pieper KS et al (1992) Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era. J Am Coll Cardiol 20:1482CrossRefPubMed
36.
Zurück zum Zitat de Waha S, Jobs A, Eitel I et al (2018) Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care 7:28CrossRefPubMed de Waha S, Jobs A, Eitel I et al (2018) Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care 7:28CrossRefPubMed
37.
Zurück zum Zitat Thiele H, Akin I, Sandri M et al (2017) PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med 377:2419CrossRefPubMed Thiele H, Akin I, Sandri M et al (2017) PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med 377:2419CrossRefPubMed
38.
Zurück zum Zitat Wong SC, Sleeper LA, Monrad ES et al (2001) Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK Trial Registry. J Am Coll Cardiol 38:1395CrossRefPubMed Wong SC, Sleeper LA, Monrad ES et al (2001) Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK Trial Registry. J Am Coll Cardiol 38:1395CrossRefPubMed
39.
Zurück zum Zitat Sleeper LA, Ramanathan K, Picard MH et al (2005) Functional status and quality of life after emergency revascularization for cardiogenic shock complicating acute myocardial infarction. J Am Coll Cardiol 46:266CrossRefPubMed Sleeper LA, Ramanathan K, Picard MH et al (2005) Functional status and quality of life after emergency revascularization for cardiogenic shock complicating acute myocardial infarction. J Am Coll Cardiol 46:266CrossRefPubMed
40.
Zurück zum Zitat Hochman JS, Sleeper LA, Webb JG et al (2006) Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA 295:2511CrossRefPubMedPubMedCentral Hochman JS, Sleeper LA, Webb JG et al (2006) Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA 295:2511CrossRefPubMedPubMedCentral
Metadaten
Titel
Infarktbedingter kardiogener Schock
Prognose und Behandlung
verfasst von
PD Dr. R. Prondzinsky
H. Lemm
A. Geppert
M. Buerke
M. Russ
K. Werdan
Publikationsdatum
02.05.2018
Verlag
Springer Medizin
Erschienen in
Medizinische Klinik - Intensivmedizin und Notfallmedizin / Ausgabe 4/2018
Print ISSN: 2193-6218
Elektronische ISSN: 2193-6226
DOI
https://doi.org/10.1007/s00063-018-0428-8

Weitere Artikel der Ausgabe 4/2018

Medizinische Klinik - Intensivmedizin und Notfallmedizin 4/2018 Zur Ausgabe

Mitteilungen der DGIIN

Mitteilungen der DGIIN

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.