Abstract
Cardiogenic shock is an extreme manifestation of acute decompensated heart failure.
Cardiogenic shock is often caused by—and has traditionally been studied in the setting
of—acute myocardial infarction (AMI CS); however, there is increasing incidence and
recognition of cardiogenic shock not associated with acute myocardial infarction (non-AMI
CS) as a distinct entity. Despite decades of study and technologic advancements, cardiogenic
shock mortality remains as high as 50%, regardless of etiology. New approaches to
shock phenotyping and classification have emerged, with a focus on appropriately matching
patient physiology to a growing list of available interventions. Further study is
needed to determine whether these efforts will lead to more nuanced use of mechanical
circulatory support and improved patient outcomes, especially in non-AMI CS. In the
meantime, models of care incorporating multidisciplinary decision making, such as
shock teams, may improve patient selection and outcomes.
Résumé
Le choc cardiogénique est une manifestation extrême de l’insuffisance cardiaque aiguë
décompensée. Il est souvent causé par un infarctus aigu du myocarde, et les études
portant sur cette complication sont habituellement menées dans ce contexte. Toutefois,
on observe une incidence grandissante des cas de chocs cardiogéniques non associés
à un infarctus aigu du myocarde en tant qu’entité distincte. Malgré des décennies
d’études et de progrès technologiques, la mortalité associée au choc cardiogénique
continue d’atteindre les 50 %, peu importe la cause. Or, de nouvelles approches ont
émergé relativement au phénotypage et à la classification du choc cardiogénique. Elles
visent entre autres à choisir les interventions parmi une liste croissante de possibilités
en fonction de la physiologie de chaque patient. D'autres études sont requises afin
de déterminer si ces efforts mèneront à une utilisation plus nuancée de l’assistance
circulatoire mécanique et à une amélioration des résultats pour les patients, particulièrement
dans les cas de chocs cardiogéniques non associés à un infarctus aigu du myocarde.
Entretemps, des modèles de soins misant sur une approche décisionnelle multidisciplinaire,
par exemple des équipes de choc, peuvent améliorer la sélection des patients et les
résultats obtenus.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: January 30, 2023
Accepted:
January 19,
2023
Received:
November 19,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
See page 12 for disclosure information.
Identification
Copyright
© 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
