Mechanical circulatory support in cardiogenic shock: a critical appraisal

Expert Rev Cardiovasc Ther. 2022 May 19. doi: 10.1080/14779072.2022.2078702. Online ahead of print.ABSTRACTINTRODUCTION: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is a life-threatening condition frequently encounter in patients with multivessel coronary artery disease (MVD).AREAS COVERED: Despite prompt revascularization, in particular percutaneous coronary intervention (PCI), and therapeutic and technological advances, the mortality rate for CS related to AMI remain unacceptably high. Differently form hemodynamically stable setting, a culprit lesion-only (CLO) revascularization strategy is currently suggested in AMI-CS patients, based on the results of a recent randomized evidence burdened by several limitations and conflicting results from non-randomized studies. Furthermore, mechanical circulatory support (MCS) devices have raised as a key therapeutic option in CS, especially in case of an early implantation without delaying revascularization and before irreversible organ damage has occurred. We provide an in-depth review of current evidences on optimal revascularization strategies of multivessel CAD in infarct-related CS, assessing the role of different type of MCS devices, and highlighting the importance of shock teams and medical care system networks to effectively impact on clinical outcomes.EXPERT OPINION: Emerging observational experience suggested that an early implantation of MCS (prior to PCI), the performance of an extensive revascul...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Authors: Source Type: research