Unresolved Controversies in Revascularization for Cardiogenic Shock with Acute Myocardial Infarction.

Cardiogenic shock occurs in 5–10% of patients with acute myocardial infarction (AMI). Routine early culprit-vessel revascularization and selective microaxial flow pump placement improve survival, but the management of multivessel coronary artery disease (CAD) in patients with cardiogenic shock remains controversial. Randomized trials are needed to address the optimal mode and timing of coronary revascularization with respect to the initiation of mechanical circulatory support. Ventricular unloading prior to multivessel percutaneous coronary intervention and emergency coronary artery bypass grafting remain intriguing options for multivessel CAD in patients with AMI and cardiogenic shock, but these strategies must be tested in prospective clinical trials.