Coronary Revascularization and Use of Hemodynamic Support in Acute Coronary Syndromes.

Cardiogenic shock develops in up to 10% of patients with acute myocardial infarction and continues to have high mortality, often >50%. Early invasive treatment is the default therapeutic approach in these patients. Based on the results of the CULPRIT-SHOCK trial, culprit only revascularization during the acute phase is preferred over multivessel revascularization. Routine use of Intra-aortic balloon pump (IABP) is not recommended, however use of mechanical circulatory support has been increasing despite the fact there is limited observational data to support its use. Several studies support multivessel revascularization in patients with uncomplicated ST-segment elevation acute myocardial infarction and simple non-culprit lesions to improve subsequent clinical outcomes.