ABSTRACT
Despite tremendous advances in the treatment of myocardial infarction (MI) over the last 25 years, the incidence of cardiogenic shock after MI remains relatively unchanged and it is still a major cause of death in patients hospitalized with acute MI.1-4 Patients with cardiogenic shock enrolled in the Global Utilization of Streptokinase and TissuePlasminogen Activator for Occluded Coronary Arteries (GUSTO-1) trial represent the largest prospectively collected population of post-MI cardiogenic shock. In this trial, cardiogenic shock occurred in 7.2% of MI patients enrolled, and the 30-day mortality rate for shock patients ranged from 57% for those presenting with shock to 55% for those developing shock after enrollment, and this is compared to a 30-day mortality rate of 3% in the trial for those without shock.5 Likewise, in GUSTO-IIB, the 30-day mortality for shock patients ranged from 63% in the presence of ST elevation to 72.5% for those without ST-segment elevation;2 in GUSTO-III, it was approximately 64% for all shock patients. In a US single community study of MI from 1975 to 1997, the incidence of shock was found to be about 7.1% of MI patients with an average in-hospital mortality of 71.7%.1,3 Despite some signs that survival may have improved in the latter half of the 1990s, this syndrome remains a challenge. The prudent use of echocardiography can assist in the management of these patients and assist in reducing the high mortality of this disease.
