Management of patients with cardiogenic shock complicating myocardial infarction: Expert opinion of the Association of Intensive Cardiac Care and Association of Cardiovascular Interventions of the Polish Society of Cardiology.

Despite significant advances in interventional cardiology and mechanical circulatory support (MCS) techniques, the outcomes of patients with cardiogenic shock (CS) complicating myocardial infarction (MI) remain suboptimal. The aim of this expert consensus was to provide information on the current management of patients with CS complicating MI in Poland, and to propose solutions, including systemic ones, for all stages of care. The document uses data from the Polish PL-ACS Registry of acute coronary syndromes, which includes records on more than 820 000 hospitalizations. The role of medical rescue teams was described, along with the necessity to expand their range of competencies at the level of prehospital care. The authors emphasized the importance of treating the underlying cause of CS and of direct patient transfer to centers capable of performing percutaneous coronary interventions. Current recommendations of scientific societies on MCS use were presented. The role of the Cardiac Shock Team in the management of patients with CS complicating MI was emphasized. Such teams should comprise an interventional cardiologist, a cardiothoracic surgeon, and an intensive care physician. Patients should be transferred to highly specialized CS centers, following the example of so called Cardiac Shock Care Centers described in some other countries. Criteria for the operation of such centers were proposed. Other important aspects discussed in the document include the role of rehabilitation, multidisciplinary care, and long-term follow-up of treatment outcomes. The document was developed in cooperation with experts from different scientific societies in Poland, which underlines the importance of interdisciplinary care in this patient population.