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Cardiogenic shock in patients with acute coronary syndromes 

Cardiogenic shock in patients with acute coronary syndromes
Chapter:
Cardiogenic shock in patients with acute coronary syndromes
Author(s):

Holger Thiele

and Uwe Zeymer

DOI:
10.1093/med/9780199687039.003.0049_update_002

Update:

Recent evidence from registries on cardiogenic shock mortality.

Update on the ongoing CULPRIT-SHOCK trialcomparing culprit lesion only versus multivessel PCI in cardiogenic shock.

Evidence for the use of radial access for PCI in cardiogenic shock added.

Update on levosimendan.

Update on percutaneous mechanical support devices.

Data on ventricular septal defect closure complicating myocardial infarction added.

Updated on 27 Jul 2017. The previous version of this content can be found here.
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date: 18 February 2018

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

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