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Updated: Nov 10, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Axial flow ventricular assist devices in cardiogenic shock complicating acute myocardial infarction
Laurna McGovern1, John Cosgrave2
1Cardiology, Saint James's Hospital, Dublin, Ireland lkmcgovern2@gmail.com.
Insights
Cardiogenic shock (CS) has high mortality. While Impella devices offer hemodynamic benefits, clear data is lacking to prove they reduce cardiac death, necessitating a multidisciplinary approach for optimal patient-device matching.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
Background:
- Cardiogenic shock (CS) is a primary cause of mortality in acute myocardial infarction patients.
- Inotropic therapy often fails to prevent end-organ damage in CS.
- Mechanical circulatory support (MCS) devices are explored to improve outcomes.
Purpose of the Study:
- To review and critically evaluate the scientific evidence for axial flow ventricular assist devices (e.g., Impella) in CS.
- To identify gaps in current understanding regarding their clinical efficacy.
Main Methods:
- Systematic review and critical evaluation of existing scientific literature.
- Analysis of hemodynamic benefits and clinical endpoint data.
Main Results:
- Axial flow devices like Impella demonstrate positive hemodynamic effects in CS.
- Current evidence does not clearly support their use in reducing clinical endpoints like cardiac death.
Conclusions:
- Despite hemodynamic advantages, robust data on reducing mortality from CS with Impella is limited.
- A consensus, multidisciplinary approach emphasizing timely diagnosis and appropriate MCS use is crucial.
- Ensuring the right patient receives the right device at the right time is vital for improving CS outcomes.
Abstract:
Cardiogenic shock (CS) remains the leading cause of death in patients hospitalised with acute myocardial infarction with mortality as high as 40%-50% prior to hospital discharge. The failure of inotropic therapy to maintain adequate perfusion and to prevent irreversible end-organ failure has led to attempts to improve outcomes by mechanical circulatory support (MCS) devices. Axial flow ventricular assist devices, namely Impella, are an attractive therapeutic option due to their positive haemodynamic benefits and ease of use. Despite clear beneficial haemodynamic effects, which should significantly impact on the pathophysiology of CS, there are currently no clear data to support their use in the reduction of clinical end points such as cardiac death. This review summarises and critically evaluates the current scientific evidence for the use of axial flow ventricular assist devices and highlights gaps in our understanding. Given such gaps, a consensus multidisciplinary approach, predicated on emphasising timely diagnosis and appropriate use of MCS, is vital to ensure that the right patient is paired with the right device at the right time.
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