Podsumowanie

Leczenie wstrząsu kardiogennego, zwłaszcza u osób starszych, jest jednym z największych wyzwań współczesnej kardiologii. Postęp w rozumieniu patofizjologii, rozwój nowych technologii MCS oraz rosnąca świadomość potrzeby zindywidualizowanego, zespołowego podejścia dają nadzieję na poprawę wyników. Kluczowe są: wczesne rozpoznanie wstrząsu kardiogennego (np. z użyciem SUSPECT CS), szybka stabilizacja, leczenie przyczynowe (rewaskularyzacja we wstrząsie kardiogennym związanym z AMI, interwencja we wstrząsie kardiogennym związanym z VHD), racjonalne stosowanie t-MCS w ramach zorganizowanych systemów opieki (shock teams, system „hub-and-spoke”) oraz podejmowanie decyzji terapeutycznych na podstawie kompleksowej oceny pacjenta, z uwzględnieniem jego wieku biologicznego, chorób współistniejących, preferencji i celów opieki. Wdrażanie narodowych programów leczenia wstrząsu, takich jak planowany w Polsce, może znacząco poprawić rokowanie tej krytycznie chorej grupy pacjentów. Dalsze badania są niezbędne do wypełnienia istniejących luk w wiedzy i optymalizacji opieki, szczególnie w odniesieniu do chorych w wieku podeszłym.

ABSTRACT

Cardiogenic shock in the elderly: Guidelines of the American Heart Association

Cardiogenic shock is a life-threatening condition with persistently high mortality rates of 30-60% despite significant advances in cardiovascular care. Advanced age represents a well-established, non-modifiable risk factor, and older adults comprise an increasingly large proportion of cardiogenic shock patients. Nevertheless, this vulnerable population has been consistently underrepresented in landmark clinical trials, creating substantial knowledge gaps and limiting the availability of evidence-based management guidelines which would take into account their unique needs. This comprehensive review synthesizes current scientific statements and guidelines from the American Heart Association and other major cardiovascular societies to provide an up-to-date understanding of cardiogenic shock epidemiology, pathophysiology, risk stratification and inpatient management. Particular emphasis is given to age-related risk factors and specific clinical considerations that are essential for optimizing care in older adults with cardiogenic shock.

Piśmiennictwo

1. Blumer V, Kanwar MK, Barnett CF, et al. Cardiogenic Shock in Older Adults: A Focus on Age-Associated Risks and Approach to Management: A Scientific Statement From the American Heart Association. Circulation 2024;149(14):e1051-65

2. Sinha SS, Morrow DA, Kapur NK, et al. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Evaluation and Management of Cardiogenic Shock: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2025;85(16):1618-41

3. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44(38):3720-826

4. Chieffo A, Dudek D, Hassager C, et al. Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices. EuroIntervention 2021;17(4):e274-86

5. Fraccaro C, Karam N, Möllmann H, et al. Transcatheter interventions for left-sided valvular heart disease complicated by cardiogenic shock: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the Association for Acute Cardiovascular Care (ACVC) and the ESC Working Group on Cardiovascular Surgery. EuroIntervention 2023;19(8):634-51

6. Gil RJ, Gajewski P, Pawłowski T, et al. National Cardiogenic Shock Treatment Program in Poland. Kardiol Pol 2024;82(12):1281-3

7. Waksman R, Pahuja M, van Diepen S, et al. Standardized Definitions for Cardiogenic Shock Research and Mechanical Circulatory Support Devices: Scientific Expert Panel From the Shock Academic Research Consortium (SHARC). Circulation 2023;148(14):1113-26

8. Naidu SS, Baran DA, Jentzer JC, et al. SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Am Coll Cardiol 2022;79(9):933-46

9. Damluji AA, Forman DE, van Diepen S, et al. Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association. Circulation 2020;141(2):e6-32

10. Backman WD, Levine SA, Wenger NK, Harold JG. Shared decision-making for older adults with cardiovascular disease. Clin Cardiol 2020;43(2):196-204

11. Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999;341(9):625-34

12. Møller JE, Engstrøm T, Jensen LO, et al. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med 2024;390(15):1382-93

13. Thiele H, Zeymer U, Akin I, et al. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. N Engl J Med 2023;389(14):1286-97

14. Osman M, Syed M, Patibandla S, et al. Fifteen-Year Trends in Incidence of Cardiogenic Shock Hospitalization and In-Hospital Mortality in the United States. J Am Heart Assoc 2021;10(15):e021061

15. Gąsior M, Tajstra M, Cieśla D, et al. Management of patients with myocardial infarction complicated by cardiogenic shock: Data from a comprehensive all-comer administrative database covering a population of 4.4 million. Kardiol Pol 2024;82(5):534-6

16. Kuliczkowski W, Błaziak M, Przybylski R, et al. First SHOCK-TEAM in Poland: Single hub center experience with multidisciplinary care for cardiogenic shock. Kardiol Pol 2025;83(7-8):823-1

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