Limits of reperfusion therapy for immediate cardiogenic shock complicating acute myocardial infarction

S everal investigators have demonstrated that aggressive reperfusion therapy, particularly emergency coronary angioplasty, effectively improves the poor prognosis of primary cardiogenic shock complicating acute myocardial infarction (AMI) by reducing in-hospital mortality from 80% to 90% to 15 mm Hg) using a Swan-Ganz catheter. In all cases, a mechanical complication was excluded by emergency echocardiography. The baseline clinical and angiographic characteristics of the patients are listed in Table I. Twelve patients (48%) were aged 270 years, 7 (28%) had prior AM, and 15 (60%) required prolonged cardiopulmonary resuscitation for >I5 minutes before or on admission. The location of AM was anterior in 16 patients (64%). In 3 patients, the infarct-related artery (diagnosed on the basis of total or subtotal occlusion and of the presence of intraluminal thrombus) was the left main trunk, and multiple acute coronary occlusions were observed in 2 others. Multivessel disease was present in 20 patients (80%). The emergency therapeutic interventions used are specified in Table II. Successful thrombolysis was defined as reperfusion of the infarct-related artery (grade 3 flow of the Thrombolysis in Myocardial Infarction trial) on