New therapies for cardiogenic shock.
Cardiogenic shock is a serious complication of acute myocardial infarction and occurs as a consequence of acute left ventricular failure and subsequent inappropriate tissue perfusion. While its incidence has been reported to be as high as 10% in the late 90ties, it has been steadily declining to currently less than 6% since the implementation of early revascularization as a class I indication in current guidelines. Despite recent advances in the treatment of cardiogenic shock, mortality is still high at approximately 50%. Current therapeutic approaches include early revascularization, fluid resuscitation, inotropic and vasopressor therapy, and mechanical circulatory support using intra-aortic balloon counterpulsation or percutaneous left ventricular assist devices. Novel treatment options such as specific inhibitors of inducible nitric oxide synthase or newer developments in mechanical circulatory support might be beneficial and should be tested in adequately powered randomized trials. However, difficulties in enrolling cardiogenic shock patients in randomized controlled trials are considerable. Until more data are available, cardiogenic shock patients should be treated aggressively with early revascularization and mechanical circulatory support to increase their probability of survival.
Department of Cardiology, Basel University Hospital, Basel, Switzerland. rjeger@uhbs.ch
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D005544:Forecasting; D006801:Humans; D012770:Shock, Cardiogenic / Q000628:therapy*