Acute myocardial infarction complicated by cardiogenic shock: role of mechanical circulatory support

Abstract

Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is the leading cause of in-hospital death for patients admitted with acute coronary syndromes. Expert guidelines for the care of AMI-CS patients recommend early revascularization with intra-aortic balloon pump support. Ventricular assist devices (VADs) offer the advantages of providing greater and longer-term cardiac support than an intra-aortic balloon pump and may improve outcomes when inserted early after heart failure symptoms begin. Pulsatile VADs are versatile and can provide biventricular support but are associated with a higher incidence of serious complications. The newer percutaneous VADs can normalize cardiac index and can be implanted without surgery. Therefore, early implementation of percutaneous VADs and early revascularization may reduce the high mortality of AMI-CS. However, access to revascularization and VAD support, including percutaneous VADs, is currently limited and must improve to more effectively treat AMI-CS patients.

Keywords::

• acute myocardial infarction
• axial flow
• cardiogenic shock
• centrifugal flow
• destination therapy
• heart transplantation
• intra-aortic balloon pump
• intracorporeal
• paracorporeal
• percutaneous ventricular assist device
• pulsatile flow
• ventricular assist device

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.