Cardiogenic shock is the most frequent cause of in-hospital death from acute myocardial infarction (AMI), resulting in 50,000 to 70,000 deaths per year in the United States alone. The reported incidence in recent studies of cardiogenic shock after AMI is about 5 to 7 percent. Since the mid-1980s, the incidence seems to be decreasing, possibly secondary to early reperfusion, invasive monitoring, and rapid correction of hypovolemia. Cardiogenic shock typically occurs early in the course of an AMI, with a median time of about 7 h from the onset after symptoms to the recognition of shock. Although a small minority may present to the emergency department in shock, it is more likely that a patient may develop signs of shock while in the department. Some factors have been identified as independent predictors of the risk for developing cardiogenic shock after AMI: advanced age, female gender, large myocardial infarction as indicated by marked increases in creatinine kinase (CK), an anterior wall infarction, previous MI, previous congestive heart failure (CHF), multivessel disease, proximal occlusion of the left anterior descending coronary artery, and diabetes mellitus.7 Increased numbers of risk factors convey greater risk and indirectly reflect a unifying principle: The greater the amount of myocardium at risk, the greater is the probability of developing shock. Early identification of patients at increased risk may reduce the incidence of shock with aggressive strategies for reperfusion. Despite recent major advances in the treatment of acute cardiac conditions and heart failure, the mortality from cardiogenic shock remains 70 to 90 percent with medical treatment alone.
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