Cardiogenic shock natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]
Overview
Cardiogenic shock is associated with cardiac, renal and pulmonary complications. In addition, cardiogenic shock is associated with a poor prognosis, particularly in the elderly.
Complications
Complications of cardiogenic shock include:
Cardiac
A downward spiral of hypotension leading to reduced coronary perfusion leading to further hypotension and a further reduction in coronary perfusion
Neurologic
Coma
Renal
Oligurin renal failure
Pulmonary
Cardiogenic pulmonary edema
Prognosis
- CS occurs in 8% of hospitalized STEMI patient with a mortality rate of 50-60% within 30 days.[1]
- Cardiogenic shock carries a very poor prognosis, particularly in the elderly. In the GUSTO 1 trial, the following were identified as correlates of higher mortality among patients with cardiogenic shock:[2]
- Older age
- Prior MI
- Signs of hypoperfusion including cold, clammy skin
- Altered mental state
- Oliguria
- CS is associated with more severe lesions in coronary territories with 53% with three vessel diseases and 16 with only left main disease.[3]
- The mortality rate in cardiogenic shock is significantly higher when the culprit lesion is in the left main artery or saphenous vein graft compared to that with lesions in the circumflex, left anterior descending, or right coronary artery.[4]
- There is no difference in the mortality rate in cardiogenic shock between STEMI and NSTEMI.[5]
- The left ventricular ejection fraction (LVEF) and the severity of mitral regurgitation (MR) are echocardiographic predictors for mortality in cardiogenic shock.[6]
- The only way to prevent CS or to improve the outcomes is the early reperfusion therapy for MI. As the early revascularization therapy particularly by PCI shows global improvement in echocardgiographic indicators as LVEF and MR grade.[6]
References
- ↑ Antman, EM.; Hand, M.; Armstrong, PW.; Bates, ER.; Green, LA.; Halasyamani, LK.; Hochman, JS.; Krumholz, HM.; Lamas, GA. (2008). "2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 51 (2): 210–47. doi:10.1016/j.jacc.2007.10.001. PMID 18191746. Unknown parameter
|month=ignored (help) - ↑ Hasdai D, Califf RM, Thompson TD, et al. Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction. J Am Coll Cardiol. Jan 2000;35(1):136-43.
- ↑ Wong, SC.; Sanborn, T.; Sleeper, LA.; Webb, JG.; Pilchik, R.; Hart, D.; Mejnartowicz, S.; Antonelli, TA.; Lange, R. (2000). "Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?". J Am Coll Cardiol. 36 (3 Suppl A): 1077–83. PMID 10985708. Unknown parameter
|month=ignored (help) - ↑ Sanborn, TA.; Sleeper, LA.; Webb, JG.; French, JK.; Bergman, G.; Parikh, M.; Wong, SC.; Boland, J.; Pfisterer, M. (2003). "Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial". J Am Coll Cardiol. 42 (8): 1373–9. PMID 14563577. Unknown parameter
|month=ignored (help) - ↑ Holmes, DR.; Berger, PB.; Hochman, JS.; Granger, CB.; Thompson, TD.; Califf, RM.; Vahanian, A.; Bates, ER.; Topol, EJ. (1999). "Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation". Circulation. 100 (20): 2067–73. PMID 10562262. Unknown parameter
|month=ignored (help) - ↑ 6.0 6.1 Picard, MH.; Davidoff, R.; Sleeper, LA.; Mendes, LA.; Thompson, CR.; Dzavik, V.; Steingart, R.; Gin, K.; White, HD. (2003). "Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock". Circulation. 107 (2): 279–84. PMID 12538428. Unknown parameter
|month=ignored (help)