Acute Myocardial Infarction and Cardiogenic Shock Interventional Approach to Management in the Cardiac Catheterization Laboratories

Despite advances in early reperfusion and a technologic renaissance in the space of Mechanical Circulatory Support (MCS), Cardiogenic Shock (CS) remains the leading cause of in-hospital mortality following Acute Myocardial Infarction (AMI). Given the challenges inherent to conducting adequately powe...

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Bibliographic Details
Published in:Current cardiology reviews 2022-03, Vol.18 (2), p.e251121198293-e251121198293
Main Authors: Tehrani, Behnam N, Damluji, Abdulla A, Batchelor, Wayne B
Format: Article
Language:English
Subjects:
Aged
Best practice
Cardiac catheterization
Cardiac Catheterization - adverse effects
Catheterization
Clinical trials
Heart
Heart attacks
Hemodynamics
Humans
Intubation
Laboratories
Myocardial infarction
Myocardial Infarction - complications
Myocardial Infarction - therapy
Patients
Reperfusion
Shock
Shock, Cardiogenic - diagnosis
Shock, Cardiogenic - etiology
Shock, Cardiogenic - therapy
Treatment Outcome
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Summary:Despite advances in early reperfusion and a technologic renaissance in the space of Mechanical Circulatory Support (MCS), Cardiogenic Shock (CS) remains the leading cause of in-hospital mortality following Acute Myocardial Infarction (AMI). Given the challenges inherent to conducting adequately powered randomized controlled trials in this time-sensitive, hemodynamically complex, and highly lethal syndrome, treatment recommendations have been derived from AMI patients without shock. In this review, we aimed to (1) examine the pathophysiology and the new classification system for CS; (2) provide a comprehensive, evidence-based review for best practices for interventional management of AMI-CS in the cardiac catheterization laboratory; and (3) highlight the concept of how frailty and geriatric syndromes can be integrated into the decision process and where medical futility lies in the spectrum of AMI-CS care. Management strategies in the cardiac catheterization laboratory for CS include optimal vascular access, periprocedural antithrombotic therapy, culprit lesion versus multi-vessel revascularization, selective utilization of hemodynamic MCS tailored to individual shock hemometabolic profiles, and management of cardiac arrest. Efforts to advance clinical evidence for patients with CS should be concentrated on (1) the coordination of multi-center registries; (2) development of pragmatic clinical trials designed to evaluate innovative therapies; (3) establishment of multidisciplinary care models that will inform quality care and improve clinical outcomes.
ISSN:1573-403X
1875-6557
DOI:10.2174/1573403X17666211125090929