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Revascularization in cardiogenic shock

Revaskularisierung bei kardiogenem Schock

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Abstract

Approximately 10% of patients with acute myocardial infarction develop cardiogenic shock. Randomized studies have shown a significant improvement in survival with early revascularization, which now represents the most important cornerstone in the treatment of infarct-related cardiogenic shock. In the vast majority of cases, this is achieved by percutaneous coronary intervention (PCI). In cases of complex coronary anatomy or mechanical complications, the Heart Team should be consulted promptly. The randomized CULPRIT-SHOCK study showed a survival advantage for patients with multivessel coronary artery disease and a percutaneous revascularization strategy who were treated by culprit-lesion-only PCI compared with immediate multivessel PCI. There are currently few data on anticoagulation and antiplatelet therapy in cardiogenic shock as well as on active mechanical circulatory support in this setting.

Zusammenfassung

In etwa 10 % der Fälle entwickelt sich bei Patienten mit akutem Myokardinfarkt ein kardiogener Schock. Nachdem randomisierte Studien eine deutliche Verbesserung der Überlebenswahrscheinlichkeit im Fall einer frühzeitigen Revaskularisierung belegten, bildet diese den wichtigsten Eckpfeiler in der Therapie des infarktbedingten Schocks. Im überwiegenden Teil der Fälle erfolgt die Revaskularisierung durch eine perkutane Koronarintervention. Bei einer komplexen Koronaranatomie oder dem Auftreten mechanischer Komplikationen des Herzinfarkts sollte zeitnah das Heart Team konsultiert werden. In der randomisierten CULPRIT-SHOCK-Studie zeigte sich im Fall einer koronaren Mehrgefäßerkrankung ein Überlebensvorteil für Patienten mit initial alleiniger Versorgung des infarktverursachenden Gefäßes im Vergleich zur sofortigen Mehrgefäßintervention bei einer perkutanen Revaskularisierungsstrategie. Bezüglich Empfehlungen zur Antikoagulation und Thrombozytenaggregationshemmung sowie zum Einsatz von aktiven Kreislaufunterstützungssystemen ist die zugrunde liegende Evidenz aktuell gering.

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany

    Anne Freund MD, Steffen Desch MD & Holger Thiele MD

  2. German Center for Cardiovascular Research (DZHK), Berlin, Deutschland

    Anne Freund MD & Steffen Desch MD

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  1. Anne Freund MD
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Correspondence to Anne Freund MD.

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A. Freund, S. Desch and H. Thiele declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Freund, A., Desch, S. & Thiele, H. Revascularization in cardiogenic shock. Herz 45, 537–541 (2020). https://doi.org/10.1007/s00059-020-04956-6

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