Management of cardiogenic shock complicating acute myocardial infarction: towards evidence based medical practice.

The treatment of cardiogenic shock is the ultimate challenge of our ability to manage patients presenting with acute myocardial infarction. Despite advances in the treatment of infarcts with thrombolysis, there has been no significant decrease in the incidence of cardiogenic shock, which has remained at 7–10% during the last 20 years. Hospital mortality was over 90% in the 1970s and is still high, in the region of 45–80%, in the 1990s. 7–9 Attitudes towards treatment of cardiogenic shock range from resignation, providing supportive measures only, to aggressive intervention. In the era of evidence based medical practice, are there data to support adoption of either extreme of approach?