Cardiogenic Shock

Cardiogenic Shock

  • hendry purnasidha bagaswoto Cardiology and Vascular Educational ProgramFaculty of Medicine / Dr. Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta
Keywords: cardiogenic shock, classification, heart failure, myocardial infarction, SCAI

Abstract

Abstract: Cardiogenic shock (CS) is the most common cause of death in hospitalized patients with acute myocardial infarction (AMI). The incidence and mortality of CS in hospitals is also high, although advanced therapy is widely used in CS patients. CS is a condition characterized by inadequate cardiac output due to primary cardiovascular diseases, leading to clinical and biochemical manifestations of insufficient tissue perfusion. CS complicates 5–10% of AMI. STEMI increases the risk of CS approximately twice as much as NSTEMI. In the last 10 years, in-hospital mortality due to CS that occurs in AMI has not changed, that is at 40-50%. The pathophysiology of CS shows several overlaps and can occur simultaneously, that is starting with a cardiac insult that reduces cardiac output, central hemodynamic changes, microcirculatory dysfunction, systemic inflammatory response syndrome, and multi-organ dysfunction. CS classification based on SCAI, divided into 5, that’s A(at risk), B(beginning CS), C(classic CS), D(deteriorating), and E(extremis). The key to managing CS is treating the patient as soon as possible, as each higher SCAI shock stage was associated with increased hospital mortality. All patients with suspected ACS-associated CS should have an early invasive strategy with appropriate revascularization. Vasoactive medicines have the potential to improve hemodynamics but at the expense of increased myocardial oxygen consumption and arrhythmogenic risk. Mechanical circulatory support (MCS) has insufficient data as the first-line device solution for CS patients. However, the use of durable MCS devices in a bridge-to-bridge strategy is becoming more prevalent and is supported by clinical recommendations. APACHE-III and SAPS-II, had the best mortality discrimination values to assess the outcome in CS patients.

Keywords: cardiogenic shock, classification, heart failure, myocardial infarction, SCAI

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References

1. Baran DA, Grines CL, Bailey S, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv. 2019;94(1):29-37.
2. Berg DD, Bohula EA, van Diepen S, et al. Epidemiology of Shock in Contemporary Cardiac Intensive Care Units. Circ Cardiovasc Qual Outcomes. 2019;12(3):e005618.
3. Boissier F, Katsahian S, Razazi K, et al. Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome. Intensive Care Med. 2013;39(10):1725-1733.
4. Bonello L, Laine M, Puymirat E, et al. Etiology and Prognosis of Cardiogenic Shock in a Secondary Center without Surgical Back-Up. Cardiol Res Pract. 2019;2019:3869603.
5. Chioncel O, Parissis J, Mebazaa A, Thiele H, Desch S, Bauersachs J et al. Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2020;22(8):1315-1341.
6. De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-789.
7. Goldberg RJ, Spencer FA, Gore JM, Lessard D, Yarzebski J. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009;10;119(9):1211-9.
8. Henry TD, Tomey MI, Tamis-Holland JE, et al. Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation. 2021;143(15):e815-e829.
9. Hollenberg SM, Clifford JK, Joseph EP. Cardiogenic Shock. Ann Intern Med. 1999;131 (1):47-59.
10. Jantti T, Tarvasmaki T, Harjola VP, Parissis J, Pulkki K, Sionis A, Silva-Cardoso J, Køber L, Banaszewski M, Spinar J, Fuhrmann V, Tolonen J, Carubelli V, di Somma S, Mebazaa A, Lassus J; CardShock Investigators. Frequency and prognostic significance of abnormal liver function tests in patients with cardiogenic shock. Am J Cardiol. 2017;120:1090–1907.
11. Jentzer JC, Burstein B, Van Diepen S, Murphy J, Holmes DR, Bell MR et al. Defining Shock and Preshock for Mortality Risk Stratification in Cardiac Intensive Care Unit Patients. Circulation: Heart Failure. 2021;14(1): e007678.
12. Jentzer JC, van Diepen S, Barsness GW, et al. Cardiogenic Shock Classification to Predict Mortality in the Cardiac Intensive Care Unit. J Am Coll Cardiol. 2019;74(17):2117-2128.
13. Jones TL, Nakamura K, McCabe JM. Cardiogenic shock: evolving definitions and future directions in management. Open Heart. 2019;6(1):e000960.
14. Kirklin JK, Naftel DC, Pagani FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34(12):1495-1504.
15. Mebazaa A, Combes A, van Diepen S, Hollinger A, Katz JN, Landoni G, Hajjar LA, Lassus J, Lebreton G, Montalescot G, Park JJ, Price S, Sionis A, Yannopolos D, Harjola VP, Levy B, Thiele H. Management of cardiogenic shock complicating myocardial infarction. Intensive Care Med. 2018;44(6):760-773.
16. Naidu SS, Baran DA, Jentzer JC, Hollenberg SM, van Diepen S, Basir MB et al. SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. Journal of the American College of Cardiology. 2022;79(9):933-946.
17. Pepe M, Bortone AS, Giordano A, et al. Cardiogenic Shock Following Acute Myocardial Infarction: What's New?. Shock. 2020;53(4):391-399.
18. Samsky MD, Morrow DA, Proudfoot AG, Hochman JS, Thiele H, Rao SV. Cardiogenic Shock After Acute Myocardial Infarction: A Review. JAMA. 2021;326(18):1840–1850.
19. Sánchez-Salado, JC., Virginia B., Albert A, Alessandro Sionis, Angela C, José L. Bernal, Cristina F, Cristina C, Marta, Esteban, Rosa, Fernando W, Manuel, Javier, Ana V, Victòria, Oriol, Isaac, José G, Nicolás M, Ángel, Héctor, Javier. Trends in cardiogenic shock management and prognostic impact of type of treating center. Rev Esp Cardiol. 2020;73(7):546–553.
20. Schrage B, Becher PM, Goßling A, Savarese G, Dabboura S, Yan I, Beer B, Söffker G, Seiffert M, Kluge S, Kirchhof P, Blankenberg S, Westermann D. Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock. ESC Heart Fail. 2021 Apr;8(2):1295-1303.
21. Tyler J, Henry J, Garberich R, Sharkey S, Larson D, Traverse J, Henry TD. The impact of cardiac arrest and cardiogenic shock on outcomes in st-elevation myocardial infarction. Am Coll Cardiol. 2019;73 9(1):167.
22. Vahdatpour C, Collins D, Goldberg S. Cardiogenic Shock. J Am Heart Assoc. 2019;8(8):e011991.
23. van Diepen S, Katz JN, Albert NM, et al. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation. 2017;136(16):e232-e268.
24. Wang J, Shen B, Feng X, Zhang Z, Liu J and Wang Y. A Review of Prognosis Model Associated With Cardiogenic Shock After Acute Myocardial Infarction. Front. Cardiovasc. Med. 2021;8:754303.
25. Werdan, K., Martin R., Michael B., George D., Alexander G., Friedrich A.S. Cardiogenic Shock Due to Myocardial Infarction: Diagnosis, Monitoring and Treatment. Dtsch Arztebl Int. 2012; 109(19): 343-51
Published
2022-06-30
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How to Cite
bagaswoto, hendry. (2022). Cardiogenic Shock. Indonesian Journal of Cardiology, 43(2), 90-9. https://doi.org/10.30701/ijc.1505