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Answer 2
  1. Early cardiac catheterization followed by revascularization by PCI or surgical revascularization. The SHOCK trial compared emergent revascularization for cardiogenic shock due to MI with initial medical stabilization and delayed revascularization.3 The results of the study revealed a mortality benefit at 30 days that increased over time at 6 months and 1 year. The American College of Cardiology/ American Heart Association guidelines recommend early revascularization (either PCI or coronary artery bypass grafting) for patients aged 75 years or younger with ST elevation or left bundle-branch block who develop shock within 36 hours of MI and who are suitable for revascularization that can be performed within 18 hours of shock.1 Patients admitted to hospitals without facilities for revascularization should be immediately transferred to a tertiary care center with such facilities.

     Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST- elevation myocardial infarction-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) [published erratum appears in Circulation 2005;111:2013]. Circulation 2004;110:588-636..

    3. 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;341:625-34.

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