Cardiogenic shock from left ventricular dysfunction complicating an acute ST-elevation myocardial infarction.

Cardiogenic shock from left ventricular dysfunction complicating an acute ST-elevation myocardial infarction is associated with high mortality. Much of the current understanding of the importance of emergency revascularization comes from the SHOCK trial. Mortality benefits combined with improved quality of life among the survivors justify the routine use of emergency revascularization in patients <75 years of age and in selected patients >or=75 years of age. This article discusses the SHOCK trial and potential mechanisms of benefit from revascularization as well as more recent information. Adjunctive therapies have been disappointing. To further improve outcomes, earlier pre-emptive and preventive strategies to ensure early revascularization should be pursued.