Myocardial Revascularization in Infarct-related Cardiogenic Shock

Acute myocardial infarction is complicated by cardiogenic shock in about 10% of patients. The most important causal treatment in these patients as shown in a randomized trial is early revascularization which is associated with improved survival in comparison to medical therapy alone. Percutaneous coronary intervention is the predominant method of revascularization in cardiogenic shock. In cases of mechanical infarct-related complications or complex coronary anatomy, early consultation of the heart team is recommended. The randomized CULRPIT-SHOCK study found that intervention of the culprit lesion only improves survival in patients with multivessel coronary artery disease compared to additional intervention of non-culprit lesions in the emergency setting. Evidence addressing anticoagulant and antiplatelet therapy in cardiogenic shock is scarce.