Hemodynamic Support Devices for Shock and High-Risk PCI: When and Which One

This article addresses evolving devices and uses of hemodynamic support in the management of high-risk PCI and AMI with cardiogenic shock.

Recent publications question the benefit of Intra-aortic Balloon Pump support for AMI Shock. Furthermore, in high-risk PCI, the Impella support system provides better late outcomes than does the intra-aortic balloon pump. We have entered a new era in which larger, higher flow devices that increase cardiac output while unloading the left ventricle provide better outcome. The current PCI population is higher risk, and often without surgical options. Hemodynamic support, most often utilizing Impella support, improves outcomes via providing the hemodynamic stability to allow complete revascularization and optimal lesion treatment. Regarding shock, preliminary data suggests that a concept of early left ventricular unloading before PCI maybe the critical factor for improving the outcome for acute myocardial infarction complicating myocardial infarction.