Intensive Care Medicine

, Volume 44, Issue 6, pp 760–773 | Cite as

Management of cardiogenic shock complicating myocardial infarction

  • Alexandre MebazaaEmail author
  • Alain CombesEmail author
  • Sean van Diepen
  • Alexa Hollinger
  • Jaon N. Katz
  • Giovanni Landoni
  • Ludhmila Abrahao Hajjar
  • Johan Lassus
  • Guillaume Lebreton
  • Gilles Montalescot
  • Jin Joo Park
  • Susanna Price
  • Alessandro Sionis
  • Demetris Yannopolos
  • Veli-Pekka Harjola
  • Bruno Levy
  • Holger ThieleEmail author


Up to 10% of acute coronary syndromes are complicated by cardiogenic shock (CS) with contemporary mortality rates of 40–50%. The extent of ischemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis in this patient population. Individualized patient risk assessment plays an important role in determining appropriate revascularization, drug treatment with inotropes and vasopressors, mechanical circulatory support, intensive care support of other organ systems, hospital level of care triage, and allocation of clinical resources. This review will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of CS complicating acute coronary syndromes with a focus on (a) potential therapeutic issues from the perspective an interventional cardiologist, an emergency physician, and an intensive care physician, (b) the type of revascularization, and (c) new therapeutic advancements in pharmacologic and mechanical percutaneous circulatory support.


Acute myocardial infarction Cardiogenic shock Catecholamines Mechanical circulatory support 



American Heart Association


Acute kidney injury


Alanine aminotransferase


Acute myocardial infarction


Aspartate aminotransferase


Blood pressure


Coronary artery bypass graft


Coronary care unit


Cardiac index


Central venous pressure


Cardiogenic shock




Extracorporeal circulatory life support


Extracorporeal membrane oxygenation


European Resuscitation Council


European Society of Cardiology


European Society of Intensive Care Medicine


Intra-aortic balloon pump


Intensive care unit


Kidney Disease: Improving Global Outcomes


Left ventricle


Mean arterial pressure


Mechanical circulatory support


Mechanical ventilation




Non-invasive ventilation


Non-ST-segment elevation acute coronary syndrome


Out-of-hospital cardiac arrest


Pulmonary artery catheter


Percutaneous coronary intervention


Randomized controlled trial


Renal replacement therapy


Right ventricle


Suppression of tumorigenicity 2


ST-elevation myocardial infarction


Thrombolysis In Myocardial Infarction


Targeted temperature management


Veno-arterial extracorporeal membrane oxygenation


Ventricular septal defect


Ventricular septal rupture


Compliance with ethical standards

Conflict of interest

AM received lecture fees from Novartis, Orion, and Abbott, research grants from Roche, and consultant fees from Servier and Sanofi. GL received speaker fees from Orion, Abbvie, and Tenax (companies producing or commercializing levosimendan). BL received lecture fees from Pulsion, Baxter, Orion, and Lilly, and consultant fees from Novartis, Orion, and Baxter. Other coauthors have no conflicts to declare.

Supplementary material

134_2018_5214_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 11 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Alexandre Mebazaa
    • 1
    • 2
    • 3
    • 4
    Email author
  • Alain Combes
    • 5
    Email author
  • Sean van Diepen
    • 6
  • Alexa Hollinger
    • 2
    • 3
    • 7
  • Jaon N. Katz
    • 8
  • Giovanni Landoni
    • 9
    • 10
  • Ludhmila Abrahao Hajjar
    • 11
  • Johan Lassus
    • 12
  • Guillaume Lebreton
    • 13
    • 14
  • Gilles Montalescot
    • 14
    • 15
  • Jin Joo Park
    • 16
  • Susanna Price
    • 17
  • Alessandro Sionis
    • 18
    • 19
  • Demetris Yannopolos
    • 20
  • Veli-Pekka Harjola
    • 21
  • Bruno Levy
    • 22
    • 23
    • 24
  • Holger Thiele
    • 25
    Email author
  1. 1.University Paris DiderotParisFrance
  2. 2.APHP, Department of Anesthesia, Burn and Critical CareHôpitaux Universitaires Saint Louis LariboisièreParisFrance
  3. 3.U 942 InsermParisFrance
  4. 4.INI-CRCTParisFrance
  5. 5.Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition UMRS_1166-ICAN, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Hôpital Pitié–SalpêtrièreParisFrance
  6. 6.Department of Critical Care and Division of CardiologyUniversity of AlbertaEdmontonCanada
  7. 7.Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain TherapyUniversity Hospital BaselBaselSwitzerland
  8. 8.Department of CardiologyUniversity of North CarolinaChapel HillUSA
  9. 9.Vita-Salute San Raffaele UniversityMilanItaly
  10. 10.Department of Anaesthesia and Intensive CareSan Raffaele Scientific InstituteMilanItaly
  11. 11.Department of Cardiopneumology, Instituto do CoracaoUniversidade de São Paulo – Hospital SirioLibanesSão PauloBrazil
  12. 12.Cardiology, Heart and Lung CenterHelsinki University and Helsinki University HospitalHelsinkiFinland
  13. 13.Department of Cardiac SurgeryAPHP, Hôpital La Pitié SalpétrièreParisFrance
  14. 14.Université Pierre et Marie CurieParisFrance
  15. 15.Department of CardiologyAPHP, Hôpital La Pitié SalpétrièreParisFrance
  16. 16.Cardiovascular Center, Division of Cardiology, Department of Internal MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
  17. 17.Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton HospitalLondonUK
  18. 18.Acute and Intensive Cardiac Care Unit, Cardiology Department, Hospital Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaSpain
  19. 19.CiberCV, Institute of Health Carlos III, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaSpain
  20. 20.Interventional CardiologyMinneapolisUSA
  21. 21.Department of Emergency Medicine and Services, Helsinki University HospitalUniversity of HelsinkiHelsinkiFinland
  22. 22.Medical ICU, Institut du Coeur et des Vaisseaux, CHU Nancy-BraboisNancyFrance
  23. 23.Groupe Choc, équipe 2, Inserm U1116NancyFrance
  24. 24.University of LorraineNancyFrance
  25. 25.Department of Internal Medicine/CardiologyHeart Center Leipzig – University HospitalLeipzigGermany

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