Masiero Giulia, Cardaioli Francesco, Rodinò Giulio, Tarantini Giuseppe
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128 Padova, Italy.
J Clin Med. 2022 May 31;11(11):3116. doi: 10.3390/jcm11113116.
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is a life-threatening condition frequently encountered in patients with multivessel coronary artery disease (CAD). Despite prompt revascularization, in particular, percutaneous coronary intervention (PCI), and therapeutic and technological advances, the mortality rate for patients with CS related to AMI remains unacceptably high. Differently form a hemodynamically stable setting, a culprit lesion-only (CLO) revascularization strategy is currently suggested for AMI-CS patients, based on the results of recent randomized evidence burdened by several limitations and conflicting results from non-randomized studies. Furthermore, mechanical circulatory support (MCS) devices have emerged as a key therapeutic option in CS, especially in the case of their early implantation without delaying revascularization and before irreversible organ damage has occurred. We provide an in-depth review of the current evidence on optimal revascularization strategies of multivessel CAD in infarct-related CS, assessing the role of different types of MCS devices and highlighting the importance of shock teams and medical care system networks to effectively impact on clinical outcomes.
急性心肌梗死（AMI）合并心源性休克（CS）是多支冠状动脉疾病（CAD）患者中经常遇到的危及生命的情况。尽管进行了及时的血运重建，特别是经皮冠状动脉介入治疗（PCI），以及治疗和技术的进步，但与AMI相关的CS患者的死亡率仍然高得令人难以接受。与血流动力学稳定的情况不同，基于近期随机试验结果（该结果受到一些局限性的影响且非随机研究结果相互矛盾），目前建议对AMI-CS患者采用仅处理罪犯病变（CLO）的血运重建策略。此外，机械循环支持（MCS）设备已成为CS的关键治疗选择，特别是在早期植入且不延迟血运重建以及在不可逆器官损伤发生之前的情况下。我们对梗死相关CS中多支CAD的最佳血运重建策略的当前证据进行了深入综述，评估了不同类型MCS设备的作用，并强调了休克治疗团队和医疗护理系统网络对有效影响临床结局的重要性。
