Table 1.
Professional Society Guidelines for Management of Cardiogenic Shock (CS) Associated With Acute Myocardial Infarction (AMI)
| Recommendation | Recommendation class |
Level of evidence |
Year | Society |
|---|---|---|---|---|
| Non-ST-elevation myocardial infarction (NSTEMI) with CS | ||||
| Emergency coronary angiography | I | B | 202027 | ESC |
| Revascularization for cardiogenic shock | I | B | 201428 | ACCF/AHA |
| Emergency PCI of the culprit lesion is recommended for patients with CS due to NSTEMI, independent of the time delay from symptom onset, if the coronary anatomy is amenable to PCI | I | B | 202027 | ESC |
| Emergency CABG is recommended for patients with CS if the coronary anatomy is not amenable to PCI | I | B | 202027 | ESC |
| Routine immediate revascularization of nonculprit lesions in patients with NSTEMI with multivessel disease presenting with CS is not recommended | III | B | 202027 | ESC |
| ST-elevation myocardial infarction (STEMI) in CS | ||||
| Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop CS irrespective of the time delay from MI onset | I | B | 201326 | ACCF/AHA |
| Cardiac catheterization and coronary angiography with intent to perform revascularization should be performed after STEMI in patients with CS | I | B | 201326 | ACCF/AHA |
| I | B | 201729 | ESC | |
| Primary PCI should be performed in patients with STEMI and CS irrespective of time delay from MI onset | I | B | 201326 | ACCF/AHA |
| PCI of an anatomically significant stenosis in the infarct artery should be performed in patients with suitable anatomy and CS | I | B | 201326 | ACCF/AHA |
| Patients who were treated with fibrinolytic therapy or who did not receive reperfusion therapy who develop CS associated with AMI should undergo coronary angiography | I | B | 201326 | ACCF/AHA |
| PCI of an infarct artery in patients who were treated with fibrinolytic therapy or who did not receive reperfusion therapy | I | B | 201326 | ACCF/AHA |
| Emergent CABG is indicated in patients with STEMI and coronary anatomy not amenable to PCI who have CS | I | B | 201326 | ACCF/AHA |
| Emergency revascularization with either PCI or CABG is recommended in suitable patients with CS after STEMI irrespective of the time delay from MI onset | I | B | 201326 | ACCF/AHA |
| In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI and CS who are unsuitable candidates for either PCI or CABG | I | B | 201326 | ACCF/AHA |
| PCI of a noninfarct artery may be considered in select patients with STEMI and multivessel disease who are hemodynamically stable, either at the time of primary PCI or as a planned staged procedure | IIb | B | 201326 | ACCF/AHA |
| IIa | C | 201729 | ESC | |
| Pharmacotherapies | ||||
| Inotropic/vasopressor agents may be considered for hemodynamic stabilization | IIb | C | 201729 | ESC |
| No specific recommendation | 201326 | ACCF/AHA | ||
| Temporary percutaneous mechanical circulatory support | ||||
| IABP can be useful for patients with CS after STEMI who do not quickly stabilize with pharmacological therapy | IIa | B | 201428 | ACCF/AHA |
| Alternative LV assist devices for circulatory support may be considered in patients with refractory CS | IIb | C | 201428 | ACCF/AHA |
| In select patients with MI and CS, short-term mechanical circulatory support may be considered, depending on patient age, comorbidities, neurological function, and the prospects for long-term survival and predicted quality of life | IIa | C | 201730 | ESC |
| Routine use of IABP in patients with CS and no mechanical complications due to MI is not recommended | III | B | 201729 | ESC |
| Echocardiography | ||||
| Immediate Doppler echocardiography is indicated to assess ventricular and valvular functions and loading conditions and to detect mechanical complications | I | C | 201729 | ESC |
Abbreviations: ACCF, American College of Cardiology Foundation; AHA, American Heart Association; CABG, coronary artery bypass grafting; CS, cardiogenic shock; ESC, European Society of Cardiology; IABP, intra-aortic balloon pump; LV, left ventricle; PCI, percutaneous coronary intervention.