Impact of mechanical circulatory support modalities on outcomes in acute myocardial infarction-related cardiogenic shock undergoing early revascularization: A systematic review of survival and cardiac function outcomes
DOI:
https://doi.org/10.56294/saludcyt20252087Keywords:
Acute myocardial infarction, Cardiogenic shock, Intra-aortic balloon pump, Ventricular function, left, Extracorporeal membrane oxygenation, MortalityAbstract
Introduction: Cardiogenic shock complicates 5–10% of acute myocardial infarctions and remains associated with early mortality of approximately 40%. Mechanical circulatory support devices, including intra-aortic balloon pump, Impella, and extracorporeal membrane oxygenation, are increasingly applied, yet their effect on outcomes is uncertain.
Objectives: This review aimed to systematically evaluate the impact of intra-aortic balloon pump, Impella, and extracorporeal membrane oxygenation on survival and left ventricular function in patients with acute myocardial infarction complicated by cardiogenic shock undergoing early revascularization.
Methods: A systematic search of PubMed, ScienceDirect, and the Cochrane Library was conducted up to May 1, 2025. Eligible studies included randomized controlled trials and observational studies assessing intra-aortic balloon pump, Impella, or extracorporeal membrane oxygenation in acute myocardial infarction–related cardiogenic shock. Two reviewers independently screened studies, extracted data, and assessed quality using Cochrane RoB 2.0 and ROBINS-I tools. Sixteen studies encompassing more than 35,000 patients were included.
Results: Across all modalities, mechanical circulatory support did not consistently improve short- or long-term survival. Randomized trials showed no benefit for intra-aortic balloon pump in survival or ventricular recovery. Impella use was associated with higher rates of bleeding and vascular complications without mortality advantage. Extracorporeal membrane oxygenation demonstrated the highest complication rates. Early Impella deployment showed limited potential for ventricular recovery in select cases, but results were inconsistent.
Conclusions: Despite theoretical hemodynamic benefits, current evidence does not demonstrate consistent improvements in survival or left ventricular function with intra-aortic balloon pump, Impella, or extracorporeal membrane oxygenation in acute myocardial infarction complicated by cardiogenic shock. High complication rates, particularly with Impella and extracorporeal membrane oxygenation, offset potential benefits, underscoring the need for timely revascularization rather than reliance on mechanical circulatory support.
References
1. Hochman JS. Cardiogenic shock complicating acute myocardial infarction: Expanding the paradigm. Circulation. 2003 Jun 24;107(24):2998–3002.
2. Samsky MD, Morrow DA, Proudfoot AG, Hochman JS, Thiele H, Rao S V. Cardiogenic Shock after Acute Myocardial Infarction: A Review. JAMA - J Am Med Assoc. 2021 Nov 9;326(18):1840–50.
3. Amin AP, Spertus JA, Curtis JP, Desai N, Masoudi FA, Bach RG, et al. The Evolving Landscape of Impella Use in the United States Among Patients Undergoing Percutaneous Coronary Intervention With Mechanical Circulatory Support. Circulation. 2020 Jan 28;141(4):273–84.
4. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock. N Engl J Med. 2012 Oct 4;367(14):1287–96.
5. Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJS, et al. Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol. 2017 Jan 24;69(3):278–87.
6. O’Neill WW, Kleiman NS, Moses J, Henriques JPS, Dixon S, Massaro J, et al. A prospective, randomized clinical trial of hemodynamic support with impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: The PROTECT II study. Circulation. 2012 Oct 2;126(14):1717–27.
7. Thiele H, Zeymer U, Akin I, Behnes M, Rassaf T, Mahabadi AA, et al. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. N Engl J Med. 2023 Oct 5;389(14):1286–97.
8. Thiele H, Jobs A, Ouweneel DM, Henriques JPS, Seyfarth M, Desch S, et al. Percutaneous short-term active mechanical support devices in cardiogenic shock: A systematic review and collaborative meta-analysis of randomized trials. Eur Heart J. 2017 Dec 14;38(47):3523–31.
9. Zhang Q, Han Y, Sun S, Zhang C, Liu H, Wang B, et al. Mortality in cardiogenic shock patients receiving mechanical circulatory support: a network meta-analysis. BMC Cardiovasc Disord [Internet]. 2022 Dec 1 [cited 2025 Jul 1];22(1):1–12. Available from: https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-022-02493-0
10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ [Internet]. 2021 Mar 29 [cited 2025 Jul 1];372. Available from: https://www.bmj.com/content/372/bmj.n71
11. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): Fi nal 12 month results of a randomised, open-label trial. Lancet [Internet]. 2013 [cited 2025 Jul 1];382(9905):1638–45. Available from: https://pubmed.ncbi.nlm.nih.gov/24011548/
12. Fang D, Yu D, Xu J, Ma W, Zhong Y, Chen H. Effects of intra-aortic balloon pump on in-hospital outcomes and 1-year mortality in patients with acute myocardial infarction complicated by cardiogenic shock. BMC Cardiovasc Disord [Internet]. 2023 Dec 1 [cited 2025 Jul 1];23(1). Available from: https://pubmed.ncbi.nlm.nih.gov/37644466/
13. Nishimoto Y, Inohara T, Kohsaka S, Sakakura K, Kawai T, Kikuchi A, et al. Changing Trends in Mechanical Circulatory Support Use and Outcomes in Patients Undergoing Percutaneous Coronary Interventions for Acute Coronary Syndrome Complicated With Cardiogenic Shock: Insights From a Nationwide Registry in Japan. J Am Heart Assoc [Internet]. 2023 Dec 5 [cited 2025 Jul 1];12(23). Available from: https://pubmed.ncbi.nlm.nih.gov/38038195/
14. Vallabhajosyula S, Prasad A, Sandhu GS, Bell MR, Gulati R, Eleid MF, et al. Ten-year trends, predictors and outcomes of mechanical circulatory support in percutaneous coronary intervention for acute myocardial infarction with cardiogenic shock. EuroIntervention. 2021;16(15):E1254–61.
15. Javaid AI, Michalek JE, Gruslova AB, Hoskins SA, Ahsan CH, Feldman MD. Mechanical circulatory support versus vasopressors alone in patients with acute myocardial infarction and cardiogenic shock undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv. 2024 Jan 1;103(1):30–41.
16. Ali S, Kumar M, Badu I, Farooq F, Alsaeed T, Sultan M, et al. Trends and outcomes of different mechanical circulatory support modalities for acute myocardial infarction associated cardiogenic shock in patients undergoing early revascularization. Am Hear J Plus Cardiol Res Pract [Internet]. 2024 Oct 1 [cited 2025 Jul 1];46:100468. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11490672/
17. Basir MB, Lemor A, Gorgis S, Patel KC, Kolski BC, Bharadwaj AS, et al. Early Utilization of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock: The National Cardiogenic Shock Initiative. J Am Hear Assoc Cardiovasc Cerebrovasc Dis [Internet]. 2023 Dec 5 [cited 2025 Jul 1];12(23):e031401. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10727311/
18. Schrage B, Ibrahim K, Loehn T, Werner N, Sinning JM, Pappalardo F, et al. Impella support for acute myocardial infarction complicated by cardiogenic shock: Matched-pair iabp-shock II trial 30-day mortality analysis. Circulation. 2019 Mar 5;139(10):1249–58.
19. Zeymer U, Bauer T, Hamm C, Zahn R, Weidinger F, Seabra-Gomes R, et al. Use and impact of intra-aortic balloon pump on mortality in patients with acute myocardial infarction complicated by cardiogenic shock: Results of the Euro Heart Survey on PCI. EuroIntervention. 2011 Aug;7(4):437–41.
20. Kim HK, Jeong MH, Ahn Y, Sim DS, Chae SC, Kim YJ, et al. Clinical outcomes of the intra-aortic balloon pump for resuscitated patients with acute myocardial infarction complicated by cardiac arrest. J Cardiol [Internet]. 2016 Jan 1 [cited 2025 Jul 1];67(1):57–63. Available from: https://www.journal-of-cardiology.com/action/showFullText?pii=S0914508715001239
21. Prunea DM, Bachl E, Herold L, Kanoun Schnur SS, Pätzold S, Altmanninger-Sock S, et al. Impact of the Timing of Mechanical Circulatory Support on the Outcomes in Myocardial Infarction-Related Cardiogenic Shock: Subanalysis of the PREPARE CS Registry. J Clin Med [Internet]. 2024 Mar 1 [cited 2025 Jul 1];13(6):1552. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10971213/
22. Wilkins C, Herrera T, Nagahiro M, Weathers L, Girotra S, Sandhu F. Outcomes of Hemodynamic Support With Impella for Acute Myocardial Infarction Complicated by Cardiogenic Shock at a Rural Community Hospital Without On-Site Surgical Back-up. J Invasive Cardiol [Internet]. 2019 Feb [cited 2025 Jul 1];31(2). Available from: https://www.hmpgloballearningnetwork.com/site/jic/articles/outcomes-hemodynamic-support-impella-acute-myocardial-infarction-complicated-cardiogenic-shock-rural-community-hospital-without-site-surgical-back
23. Jin C, Yandrapalli S, Yang Y, Liu B, Aronow WS, Naidu SS. A Comparison of In-Hospital Outcomes Between the Use of Impella and IABP in Acute Myocardial Infarction Cardiogenic Shock Undergoing Percutaneous Coronary Intervention. J Invasive Cardiol [Internet]. 2022 Feb 1 [cited 2025 Jul 1];34(2):E98–103. Available from: https://pubmed.ncbi.nlm.nih.gov/35100554/
24. Klein F, Crooijmans C, Peters EJ, van ’t Veer M, Timmermans MJC, Henriques JPS, et al. Impact of symptom duration and mechanical circulatory support on prognosis in cardiogenic shock complicating acute myocardial infarction. Netherlands Hear J [Internet]. 2024 Aug 1 [cited 2025 Jul 1];32(7–8):290–7. Available from: https://link.springer.com/article/10.1007/s12471-024-01881-9
25. Ali S, Kumar M, Badu I, Farooq F, Alsaeed T, Sultan M, et al. Trends and outcomes of different mechanical circulatory support modalities for acute myocardial infarction associated cardiogenic shock in patients undergoing early revascularization. Am Hear J Plus Cardiol Res Pract [Internet]. 2024 Oct 1 [cited 2025 Jul 1];46. Available from: https://pubmed.ncbi.nlm.nih.gov/39431117/
26. Wilkins C, Herrera T, Nagahiro M, Weathers L, Girotra S, Sandhu F. Outcomes of Hemodynamic Support With Impella for Acute Myocardial Infarction Complicated by Cardiogenic Shock at a Rural Community Hospital Without On-Site Surgical Back-up. J Invasive Cardiol [Internet]. 2019 Feb [cited 2025 Jul 1];31(2). Available from: https://pubmed.ncbi.nlm.nih.gov/30700627/
27. Vallabhajosyula S, Prasad A, Sandhu GS, Bell MR, Gulati R, Eleid MF, et al. Ten-year trends, predictors and outcomes of mechanical circulatory support in percutaneous coronary intervention for acute myocardial infarction with cardiogenic shock: MCS-assisted PCI in AMI-CS. EuroIntervention [Internet]. 2021 [cited 2025 Jul 1];16(15):e1254. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9725008/
28. Zeymer U, Bauer T, Hamm C, Zahn R, Weidinger F, Seabra-Gomes R, et al. Use and impact of intra-aortic balloon pump on mortality in patients with acute myocardial infarction complicated by cardiogenic shock: results of the Euro Heart Survey on PCI. EuroIntervention. 2011;7:437–41.
29. Nishimoto Y, Ohbe H, Nakata J, Takiguchi T, Nakajima M, Sasabuchi Y, et al. Effectiveness of an Impella Versus Intra-Aortic Balloon Pump in Patients Who Received Extracorporeal Membrane Oxygenation. J Am Hear Assoc . 2025 Feb 4;14(3).
30. Shi Y, Wang Y, Sun X, Tang Y, Jiang M, Bai Y, et al. Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials. BMJ Open [Internet]. 2021 Jun 29 [cited 2025 Jul 1];11(6):e044072. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8245450/
31. Lim Y, Kim MC, Oh S, Ahn JH, Lee SH, Hyun DY, et al. Strategies of Revascularization and Mechanical Circulatory Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Systematic Review With Updated Evidence. J Cardiovasc Interv [Internet]. 2025 Jul 1 [cited 2025 Jul 1];4(3):212–22. Available from: https://doi.org/10.54912/jci.2025.0004
32. Saggu JS, Seelhammer TG, Esmaeilzadeh S, Roberts JA, Radosevich MA, Ripoll JG, et al. Mechanical Circulatory Support for Acute Myocardial Infarction Cardiogenic Shock: Review and Recent Updates. J Cardiothorac Vasc Anesth [Internet]. 2025 Apr 1 [cited 2025 Jul 1];39(4):1049–66. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1053077024009455
33. Subramaniam A V., Barsness GW, Vallabhajosyula S, Vallabhajosyula S. Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature. Cardiol Ther. 2019 Dec 1;8(2):211–28.
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Copyright (c) 2025 Melanie Mishel Ponce Saldaña, Carlos Alfredo Almazan Hernandez, Felipe Eduardo Macías Prado, Andrea Blanco Silva, Melina Carlos Tovar, Jesús Miguel Figueroa Zaldívar, Cleyber Navarro Sandoval (Author)
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