**2. Conclusion**

vicious circle. Using inotropic agents temporarily increase the cardiac output therewith peripheral perfusion but unfortunately cannot interrupt the vicious circle. Intra-aortic balloon pump is a temporary solution, improves circulation, peripheral perfusion, and relieve ischemia; however, this is not long-term complete solution. Calcium-sensitizing agents such as levosimendan have some beneficial effects including positive inotropy, increases in tissue perfusion, and anti-stunning and anti-inflammatory effects. In clinical trials, levosimendan

The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial enrolled 302 patients presented with cardiogenic shock due to left ventricular failure complicating MI. Patients were randomized in emergency revascularization (152 patients) or initial medical stabilization (150 patients) groups. Intra-aortic balloon counterpulsation was performed 86% patients. At 30 days, there was not any significant difference between revascularization and medical therapy groups (46.7 and 56%, respectively; p = 0.11). In revascularization group, the mortality rates were significantly lower than medication group at 6-month follow-ups (50.3 vs. 63.1%, respectively; p = 0,027). Interventional cardiologist should strongly considered early revascularization for the patients with MI complicated

Stent thrombosis is a rare disorder while depending on the extensity of ischemic surface, cardiogenic shock can be occur with ventricular dysfunction and become life-threatening. Cardiogenic shock mainly associated with the infarct-related territories. A study observed 92 ST segment elevated patients from January 2004 to March 2007 [29]. Of the total, 15.2% (n = 14) presented with cardiogenic shock and 85.7% (n = 12) were DES thrombosis. Coronary collateral growth is injured with DES which inhibits formation of cytokines, chemotactic proteins, and proliferation of vascular smooth muscle cells. Mean time passed from stent implantation procedure to stent thrombosis was 4.5 ± 7.6 months. 57% of the stent thrombosis occurred less than 30 days (early stent thrombosis). In 35.7% cases, MI related to left main or multivessel stent thrombosis. Before coronary angiography, all patients underwent intra-aortic balloon pump implantation [enlarges during diastole, prior to systole, and the balloon is deflated. Therefore, device augments diastolic pressure, reduces afterload, enhances coronary perfusion, and improves cardiac output [30]. In 80% of cases, revascularization was achieved, and 21% of cases, Impella LP 2.5 pump was used because of the low cardiac output persistence. In-hospital survival was 28.6%, and in the majority of cases, death occurred within the first 48 h. All the patients who survived in the acute phase were alive at 6 months visit and had significantly lower thrombus grade after wire passage (p = 0.03). However, they showed a higher rate of very late stent thrombosis, longer times from symptoms onset to revascularization, and higher TIMI flow grade both before and after percutaneous coronary intervention [29].

The IMPRESS trial compares the 30-day mortality rates of Impella CP and intra-aortic balloon pump devices in patients with severe shock complicating acute MI. Forty eight patients randomized to Impella CP (n = 24) or intra-aortic balloon pump (n = 24). At 30 days, mortality in patients treated with either intra-aortic balloon pump or Impella CP was similar (50 and 46%, respectively, p = 0.92). At 6 months, mortality rates for both Impella CP and intra-aortic

improves symptoms, cardiac function, hemodynamics, and end-organ function [27].

by cardiogenic shock [28].

174 Interventional Cardiology

balloon pump were 50% (p = 0.923) [31].

Stent thrombosis is the nightmare of interventional cardiologists with fatal complications such as cardiogenic shock. It occurs rarely but has significantly high incidence of in-hospital mortality. Primary strategy should avoid all the predisposing factors. The main reason of cardiogenic shock due to stent thrombosis is extensiveness of infarct-related myocardial tissue. Early revascularization and intensive life support to supply cardiac output with inotropic agents and/or mechanical circulatory devices are the beneficial strategies.
