The Present and Future
JACC Review Topic of the Week
Cardiac Shock Care Centers: JACC Review Topic of the Week

https://doi.org/10.1016/j.jacc.2018.07.074Get rights and content
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Abstract

Despite advances over the past decade, the incidence of cardiogenic shock secondary to acute myocardial infarction has increased, with an unchanged mortality near 50%. Recent trials have not clarified the best strategies in treatment. While dedicated cardiac shock centers are being established, there are no standardized agreements on the utilization of mechanical circulatory support and the timeliness of percutaneous coronary intervention strategies. In some centers and prospective registries, outcomes after placement of advanced mechanical circulatory support prior to reperfusion therapy with percutaneous coronary intervention have been encouraging with improved survival. Here, we suggest systems of care with a treatment pathway for patients with acute myocardial infarction complicated by cardiogenic shock.

Key Words

cardiogenic shock
care pathway
shock center

Abbreviations and Acronyms

AMI
acute myocardial infarction
AMI-CS
acute myocardial infarction-related cardiogenic shock
CS
cardiogenic shock
ECMO
extracorporeal membrane oxygenation
FMC
first medical contact
IABP
intra-aortic balloon pump
MCS
mechanical circulatory support
OHCA
out-of-hospital cardiac arrest
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

Dr. Meraj receives research, grants, education, and consulting fees from Abiomed. Dr. Basir is the co-principal investigator for the National CSI trial, for which Henry Ford Hospital receives grant funding from Abiomed and Cheisi. Dr. O'Neill has served as a consultant to Medtronic, Boston Scientific, and Abiomed; and is the principal investigator for the National CSI trial, for which Henry Ford Hospital receives grant funding from Abiomed and Cheisi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.