Treatment of NSTEMI in Cardiogenic Shock or Hemodynamic Instability

Clinical scenario

This protocol covers Non-ST-elevation myocardial infarction (NSTEMI) complicated by cardiogenic shock or hemodynamic instability — a high-risk presentation in which survival is closely tied to the speed and strategy of intervention.

Patient population

Patients with NSTEMI who develop cardiogenic shock or hemodynamic instability represent an acutely endangered subgroup. Emergency restoration of flow to the culprit vessel is indicated in these patients, regardless of how much time has passed since symptom onset.

Treatment approach (partial)

The primary focus of management is emergency revascularization targeting the culprit vessel. Whether additional coronary vessels should be addressed at the same time — and under what circumstances — is a critical part of the structured regimen.

Full procedural detail, sequencing, and vessel-selection guidance are in the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

  1. In patients with ACS and cardiogenic shock or hemodynamic instability, emergency revascularization of the culprit vessel by PCI or with CABG is indicated to improve survival, irrespective of time from symptom onset.
  2. Immediate revascularization with PCI or CABG is also recommended in high-risk patients with NSTEMI who are in cardiogenic shock.
  3. In patients with NSTE-ACS complicated by cardiogenic shock, routine PCI of a nonculprit artery at the time of index procedure should not be performed because of the higher risk of death or kidney failure.

DOI: 10.1161/CIR.0000000000001309

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