TY - JOUR
T1 - Acute Myocardial Infarction and Cardiogenic Shock Interventional Approach to Management in the Cardiac Catheterization Laboratories
AU - Tehrani, Behnam N.
AU - Damluji, Abdulla A.
AU - Batchelor, Wayne B.
N1 - Publisher Copyright:
© 2022 Bentham Science Publishers.
PY - 2022/3
Y1 - 2022/3
N2 - Despite advances in early reperfusion and a technologic renaissance in the space of Mechanical Circulatory Support (MCS), Cardiogenic Shock (CS) remains the leading cause of in-hos-pital mortality following Acute Myocardial Infarction (AMI). Given the challenges inherent to con-ducting adequately powered randomized controlled trials in this time-sensitive, hemodynamically complex, and highly lethal syndrome, treatment recommendations have been derived from AMI patients without shock. In this review, we aimed to (1) examine the pathophysiology and the new classification system for CS; (2) provide a comprehensive, evidence-based review for best practices for interventional management of AMI-CS in the cardiac catheterization laboratory; and (3) highlight the concept of how frailty and geriatric syndromes can be integrated into the decision process and where medical futility lies in the spectrum of AMI-CS care. Management strategies in the cardiac catheterization laboratory for CS include optimal vascular access, periprocedural antithrombotic therapy, culprit lesion versus multi-vessel revascularization, selective utilization of hemodynamic MCS tailored to individual shock hemometabolic profiles, and management of cardiac arrest. Ef-forts to advance clinical evidence for patients with CS should be concentrated on (1) the coordination of multi-center registries; (2) development of pragmatic clinical trials designed to evaluate in-novative therapies; (3) establishment of multidisciplinary care models that will inform quality care and improve clinical outcomes.
AB - Despite advances in early reperfusion and a technologic renaissance in the space of Mechanical Circulatory Support (MCS), Cardiogenic Shock (CS) remains the leading cause of in-hos-pital mortality following Acute Myocardial Infarction (AMI). Given the challenges inherent to con-ducting adequately powered randomized controlled trials in this time-sensitive, hemodynamically complex, and highly lethal syndrome, treatment recommendations have been derived from AMI patients without shock. In this review, we aimed to (1) examine the pathophysiology and the new classification system for CS; (2) provide a comprehensive, evidence-based review for best practices for interventional management of AMI-CS in the cardiac catheterization laboratory; and (3) highlight the concept of how frailty and geriatric syndromes can be integrated into the decision process and where medical futility lies in the spectrum of AMI-CS care. Management strategies in the cardiac catheterization laboratory for CS include optimal vascular access, periprocedural antithrombotic therapy, culprit lesion versus multi-vessel revascularization, selective utilization of hemodynamic MCS tailored to individual shock hemometabolic profiles, and management of cardiac arrest. Ef-forts to advance clinical evidence for patients with CS should be concentrated on (1) the coordination of multi-center registries; (2) development of pragmatic clinical trials designed to evaluate in-novative therapies; (3) establishment of multidisciplinary care models that will inform quality care and improve clinical outcomes.
KW - Cardiogenic shock
KW - acute myocardial infarction
KW - cardiac catheterization laboratory
KW - congestion
KW - mechanical circulatory support
KW - myocardial oxygen demand
UR - http://www.scopus.com/inward/record.url?scp=85128327729&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85128327729&partnerID=8YFLogxK
U2 - 10.2174/1573403X17666211125090929
DO - 10.2174/1573403X17666211125090929
M3 - Article
C2 - 34823461
AN - SCOPUS:85128327729
SN - 1573-403X
VL - 18
JO - Current Cardiology Reviews
JF - Current Cardiology Reviews
IS - 2
M1 - e251121198293
ER -