To the Editor We read with great interest the Viewpoint by Tchantchaleishvili et al1 calling for organized statewide networks for the management of acute myocardial infarction–related cardiogenic shock. We applaud the authors’ insights into one of the major current challenges in cardiovascular care. Despite advances in the treatment of coronary artery disease and in the technology of mechanical circulatory support devices (MCSDs), patients with myocardial infarction complicated by cardiogenic shock still have mortality rates in the range of 40% to 50%.2 While no trial since the SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial3 has demonstrated a clear benefit to any intervention beyond early revascularization, observational data suggest that improved outcomes for patients with this disease have paralleled the use of MCSDs.2 The use of MCSDs for appropriately selected patients, in conjunction with early revascularization, represents one way to improve on the unacceptably high mortality rates.
Arthur Reshad Garan, Ajay Kirtane, Hiroo Takayama. Redesigning Care for Patients With Acute Myocardial Infarction Complicated by Cardiogenic ShockThe “Shock Team”. JAMA Surg. 2016;151(7):684–685. doi:10.1001/jamasurg.2015.5514