ABSTRACT
Cardiogenic shock constitutes a dreadful complication of acute coronary syndromes, occurring predominantly after an acute myocardial infarction with ST elevation (STEMI) but also among patients with non-ST elevation acute syndromes. When occuring in the acute phase of a myocardial infarction (MI), it is usually consequent to severe left ventricular dysfunction. Cardiogenic shock may also be due to mechanical complications, represented by acute mitral valve regurgitation, and acute ventricular septal rupture. These events constitute relatively late complications of acute myocardial infarction (AMI), usually occurring more than two days after the onset of symptoms, and requiring prompt echocardiographic confirmation of diagnosis and urgent surgical correction. In large series of patients, cardiogenic shock is observed in 6-7% of AMI, with mortality rates still very high, ranging from 56% to 74% in several publications.1-6 The mortality rate in patients in cardiogenic shock in GUSTO-IIb (Global Utilization of Streptokinase and t-PA in Occluded Coronary Arteries) was similar in those with an STEMI or a non-ST elevation acute coronary syndrome.4
