INFARCTION COMPLICATED BY CARDIOGENIC SHOCK
P. Urban .
de la Tour, Geneve, Switzerland
of cardiogenic shock (CS) in the course of AMI is ca. 7 to 10%.
Prognosis remains poor and the hospital mortality varies between
50 and 80%. It is critical to realise that death occurs at an
early stage, i.e. generally during the first 48 hours after onset
of CS, and that the therapeutic interventions must therefore be
applied early to be effective.. Intravenous thrombolysis can prevent
the development of cardiogenic shock when administered before
refractory hypotension occurs, but it is ineffective when used
for patients with established CS. Mechanical revascularisation,
whether surgical or percutaneous, has been associated with an
improved prognosis in numerous retrospective studies. Recently,
two randomised prospective studies (SMASH and SHOCK) have evaluated
the benefit of emergent revascularisation. in patients with CS.
Overall, both trials demonstrated that a strategy of immediate
revascularisation, together with iv inotropes and aortic counterpulsation
support, was associated with a short term absolute mortality reduction
of 9%, and an even greater benefit (13.2% mortality reduction)
after a follow-up period of 1 year. This latter figure corresponds
to 132 lives saved for 1000 patients treated, or a NNT of 7.6.
Based on these data, it appears that urgent referral for immediate
catheterisation is the best current strategy for a majority of
patients with CS following myocardial infarction.