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November 9, 2021

Cardiogenic Shock After Acute Myocardial Infarction: A Review

Author Affiliations
  • 1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
  • 2TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 3Perioperative Medicine Department, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
  • 4Clinic For Anesthesiology & Intensive Care, Charité-Universitätsmedizin Berlin corporate member of Free University Berlin and Humboldt University Berlin, Germany
  • 5Department of Anaesthesiology & Intensive Care, German Heart Centre Berlin, Germany
  • 6Cardiovascular Clinical Research Center, Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
  • 7Department of Internal Medicine/Cardiology, Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
JAMA. 2021;326(18):1840-1850. doi:10.1001/jama.2021.18323

Importance  Cardiogenic shock affects between 40 000 and 50 000 people in the US per year and is the leading cause of in-hospital mortality following acute myocardial infarction.

Observations  Thirty-day mortality for patients with cardiogenic shock due to myocardial infarction is approximately 40%, and 1-year mortality approaches 50%. Immediate revascularization of the infarct-related coronary artery remains the only treatment for cardiogenic shock associated with acute myocardial infarction supported by randomized clinical trials. The Percutaneous Coronary Intervention Strategies with Acute Myocardial Infarction and Cardiogenic Shock (CULPRIT-SHOCK) clinical trial demonstrated a reduction in the primary outcome of 30-day death or kidney replacement therapy; 158 of 344 patients (45.9%) in the culprit lesion revascularization–only group compared with 189 of 341 patients (55.4%) in the multivessel percutaneous coronary intervention group (relative risk, 0.83 [95% CI, 0.71-0.96]; P = .01). Despite a lack of randomized trials demonstrating benefit, percutaneous mechanical circulatory support devices are frequently used to manage cardiogenic shock following acute myocardial infarction.

Conclusions and Relevance  Cardiogenic shock occurs in up to 10% of patients immediately following acute myocardial infarction and is associated with mortality rates of nearly 40% at 30 days and 50% at 1 year. Current evidence and clinical practice guidelines support immediate revascularization of the infarct-related coronary artery as the primary therapy for cardiogenic shock following acute myocardial infarction.