Why the study?
Although early revascularization has improved outcomes, 30-day mortality in patients with cardiogenic shock after AMI remains substantial at 40 to 50%, warranting a summary of current evidence on invasive strategies.
Does early revascularization improve outcomes in patients with infarct-related cardiogenic shock?
Does early revascularization improve outcomes in patients with infarct-related cardiogenic shock?
Early revascularization, specifically confined to the culprit lesion during the emergency setting, remains the cornerstone of treatment for infarct-related cardiogenic shock.
Supports culprit-only PCI as emergency standard in infarct shock; leaves open optimal complete revascularization timing.
PURPOSE OF REVIEW: Early revascularization significantly improved the outcome of patients with cardiogenic shock following acute myocardial infarction (AMI). Nevertheless, the mortality remains substantial, ranging between 40 and 50% after 30 days. The present review summarizes the current evidence regarding revascularization strategies, vascular access site and concomitant antiplatelet and antithrombotic treatment in infarct-related cardiogenic shock. RECENT FINDINGS: On the basis of the SHOCK trial, early revascularization is the most relevant procedure to improve the outcome of patients with infarct-related cardiogenic shock. The majority of these patients present with multivessel coronary disease. The randomized CULPRIT-SHOCK trial showed that in the emergency setting, percutaneous coronary intervention (PCI) should be confined to the culprit lesion. Regarding vascular access site, no data derived from randomized controlled trials in cardiogenic shock are available. Emergency coronary artery bypass grafting (CABG) is nowadays rarely performed in cardiogenic shock with rates less than 5% but is still a treatment option if coronary anatomy is not amenable to PCI. Regarding antiplatelet treatment, a randomized trial testing the intravenous P2Y12 inhibitor cangrelor versus an oral P2Y12 inhibitor in infarct-related cardiogenic shock is currently being performed. SUMMARY: Early revascularization is the cornerstone of treatment of infarct-related cardiogenic shock and should be confined to the culprit lesion in the emergency setting.
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Feistritzer et al. (2020) studied this question.
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