The conventional focus since the SHOCK trial has centered on revascularization strategies and the subsequent medical management of these patients post-PCI with ever diminishing returns. Nonetheless even in the age of percutaneous coronary intervention (PCI) of the infarct related artery, survival rates continue to be only approximately 50%. Substantial mortality gains in the acute myocardial infarction cardiogenic shock (AMI-CS) population were observed with the reported outcomes of the SHOCK trial in 1999 compared to previous populations with AMI-CS. The majority of clinical pathways and paradigms utilized in the treatment and management of cardiogenic shock with temporary mechanical circulatory support (MCS) are largely based on individual physician intuition and ad hoc problem-solving.
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