ICU SAQs · Cardiovascular / ACS
STEMI with cardiogenic shock — management and evidence
A CICM SAQ on STEMI with cardiogenic shock: SHOCK trial (early revascularisation), CULPRIT-SHOCK, IABP-SHOCK II, DAPT (PLATO) and the 2025 Australian ACS guideline.
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Prompt
A patient with an acute STEMI develops cardiogenic shock. Outline the management, including the evidence for early revascularisation and the pharmacological therapy.
Question
A patient with an acute STEMI develops cardiogenic shock. Outline the management, including the evidence for early revascularisation and the pharmacological therapy. [1]
References6ShowHide
- [1]Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. The New England journal of medicine, 1999.PMID 10460813
- [2]Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. The New England journal of medicine, 2009.PMID 19717846
- [3]Brieger DB, Cullen LA, Briffa TG, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian Clinical Guideline for Diagnosing and Managing Acute Coronary Syndromes 2025. The Medical journal of Australia, 2026.PMID 41693087
- [4]Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. The New England journal of medicine, 2012.PMID 22920912
- [5]Thiele H, Akin I, Sandri M, et al. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock. The New England journal of medicine, 2017.PMID 29083953
- [6]Møller JE, Engstrøm T, Jensen LO, et al. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. The New England journal of medicine, 2024.PMID 38587239