Mechanical Circulatory Support for Acute Myocardial Infarction Cardiogenic Shock: Review and Recent Updates.

Abstract

Cardiogenic shock (CS) in acute myocardial infarction (AMI) is a life-threatening syndrome characterized by systemic hypoperfusion that can quickly progress to multiorgan failure and death. Various devices and configurations of mechanical circulatory support (MCS) exist to support patients, each with unique pathophysiological characteristics. The Intra-aortic balloon pump can improve coronary perfusion, decrease afterload, and indirectly augment cardiac output. TandemHeart, a percutaneous ventricular assist device, can decrease left ventricular preload and directly augment cardiac output. Neither the intra-aortic balloon pump nor the percutaneous ventricular assist device has been shown to decrease mortality in the revascularization era. Venoarterial extracorporeal membrane oxygenation can offer complete cardiopulmonary support; however, it has not been shown to decrease mortality. Recent studies have indicated that microaxial flow pumps, such as Abiomed's Impella family of devices, can decrease mortality in the AMI-CS population. Managing AMI-CS requires careful clinical assessment, as no single MCS device is universally effective, and device-related complications are common. While venoarterial extracorporeal membrane oxygenation provides complete support, it has not demonstrated a mortality benefit in major trials and carries significant risks. In contrast, microaxial flow pumps have shown a mortality benefit but with higher complication rates. Ongoing research and advancements aim to refine MCS strategies, improve device safety, and enhance patient outcomes.