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Coronary Artery Interventions in Cardiogenic Shock

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PanVascular Medicine

Abstract

Although improved from the historically high mortality of 80–90 %, the current prognosis of patients with cardiogenic shock remains dismal. Because of the difficulty conducting randomized studies in patients with cardiogenic shock, there is relatively little data to guide management of these patients. Much of the data discussed below is observational with one notable exception being the SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial that demonstrated the importance of early mechanical revascularization in patients with acute myocardial infarction complicated by cardiogenic shock. Much of the recent effort to advance the field has centered upon mechanical circulatory support, which represents the next major frontier in improving outcomes for this cohort of patients.

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Abbreviations

Cardiac tamponade:

Acute type of pericardial effusion due to fluid, pus or blood, clots accumulation within the pericardial cavity associated hypotension, elevated jugular venous pressure, paradoxical pulse and distant heart sounds. Echocardiographic diagnostic criteria include right atrial systolic collapse, right ventricular diastolic collapse, reciprocal respiratory ventricular inflow, inferior vena cava congestions.

Cardiogenic shock (CS):

Is a state of circulatory collaps with end-organ hypoperfusion due to cardiac failure. The definition of CS is based on hemodynamic parameters including persistent hypotension (systolic blood pressure <80 to 90 mm Hg or mean arterial pressure 30 mm Hg lower than baseline) with severe reduction in cardiac index (<1.8 L · min−1 · m−2 without support or <2.0 to 2.2 L · min−1 · m−2 with support) and adequate or elevated filling pressure (eg., left ventricular [LV] end-diastolic pressure >18 mm Hg or right ventricular [RV] end-diastolic pressure >10 to 15 mm Hg).

Inotropes (Inotropic agents):

Agent capable to increase the force of myocardial contaction.

Paradoxical pulse:

Is a decrease in systolic blood pressure (>10mmHg) and pulse wave amplitude during inspiration.

AMI:

Acute myocardial infarction

BiVAD:

Biventricular assist device

CABG:

Coronary artery bypass grafting

CS:

Cardiogenic shock

ECMO:

Extracorporeal membrane oxygenation

GUSTO-1:

Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries study

IABP:

Intra-aortic balloon pump

LVAD:

Left ventricular assist device

MCS:

Mechanical circulatory support

NO:

Nitric oxide

NSTEMI:

Non ST-elevation myocardial infarction

PCI:

Percutaneous coronary intervention

SHOCK:

Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock trial and registry

STEMI:

ST-elevation myocardial infarction

SVR:

Systemic vascular resistance

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  1. New York-Presbyterian Hospital, Columbia University, Cardiology, 622 West 168th Street, PH3 Stem, 10032, New York, NY, USA

    Arthur Reshad Garan & LeRoy E. Rabbani

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  1. Arthur Reshad Garan
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    Peter Lanzer

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Garan, A.R., Rabbani, L.E. (2015). Coronary Artery Interventions in Cardiogenic Shock. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37078-6_72

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