Nitric Oxide Synthase Inhibitors in Refractory Cardiogenic Shock due to Myocardial Infarction after Percutaneous Coronary Intervention

ST-elevation myocardial infarction complicated by cardiogenic shock (CS), warrants optimal medical support and urgent revascularization usually by percutaneous coronary intervention (PCI). However, contemporary studies report that half of these post-PCI patients will succumb to intractable heart stunning, failure, and death. Most of those who survive, however, become asymptomatic or mildly symptomatic. We discuss current definitions of CS, and pump function, as well as the potential deleterious effects of nitric oxide on the stunned and failing heart. We review the studies employing nitric oxide synthase inhibitors for post-PCI cardiogenic shock, and point out future studies.