Related Experiment Video
Updated: May 5, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
The use of mechanical circulatory support in elective high-risk percutaneous coronary interventions: a
Alexander Geppert1, Kambis Mashayekhi2,3, Kurt Huber1,4
13rd Department of Medicine, Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, A-1160 Vienna, Austria.
Insights
Mechanical circulatory support (MCS) devices may aid high-risk percutaneous coronary interventions (HR-PCIs). While IABP use declined, V-A ECMO and Impella show potential, necessitating further trials and a new algorithm for patient selection.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Percutaneous coronary intervention (PCI) is increasingly performed in high-risk patients.
- Mechanical circulatory support (MCS) devices are used to mitigate risks during high-risk PCI (HR-PCI).
- Common MCS devices include intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (V-A ECMO), and Impella.
Purpose of the Study:
- To review clinical evidence for MCS devices in HR-PCI.
- To explore mechanisms of improved outcomes with MCS in HR-PCI.
- To propose a novel algorithm for identifying suitable candidates for MCS-assisted HR-PCI.
Main Methods:
- Review of contemporary medical literature on MCS devices in HR-PCI.
- Analysis of clinical outcomes associated with IABP, V-A ECMO, and Impella.
- Development of a predictive algorithm for MCS utilization in HR-PCI.
Main Results:
- IABP use has decreased due to lack of demonstrated benefit in HR-PCI and cardiogenic shock.
- V-A ECMO shows low major adverse cardiac and cerebrovascular events (MACCEs) but increased risks of acute kidney injury and transfusion.
- Impella use has seen declining MACCE rates with improved operator experience, though mortality benefits require further investigation via randomized trials.
Conclusions:
- Current evidence for IABP in HR-PCI is limited.
- V-A ECMO and Impella present distinct risk-benefit profiles in HR-PCI.
- A new algorithm combining anatomical, comorbidity, and clinical factors is proposed to optimize MCS selection for HR-PCI.
Abstract:
Contemporary medical practices allow complete percutaneous coronary intervention (PCI) in a considerable number of patients who previously would have been considered too 'high-risk' for such procedures. The use of mechanical circulatory support (MCS) devices during these high-risk PCIs (HR-PCIs) is thought to reduce the potential risk for major adverse events during and after revascularization. The intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (V-A ECMO), and the Impella are the most common MCS devices in use. This review aims to summarize the clinical evidence for each of these devices and the potential mechanisms for the improvement in patient outcomes in HR-PCI. The IABP use has rapidly declined in recent years due to no evidence of benefit in HR-PCI and cardiogenic shock. The V-A ECMO results in low rates of major adverse cardiac and cerebrovascular events (MACCEs) but higher rates of acute kidney injury and increased need for transfusions. In initial studies, Impella resulted in a reduced need for repeat interventions and reduced rates of hypotension, but no benefit in mortality. However, MACCE rates with Impella have gradually declined over the last 10 years, reflecting increased operator experience and technical improvements. Thus, a large, randomized trial is needed to assess the efficacy of Impella in HR-PCI with contemporary standards of care. There is currently no individual parameter that can identify patients who would benefit from MCS use in elective HR-PCI. To address this gap, we propose an algorithm that combines anatomical complexity, comorbidities, and clinical presentation to accurately identify candidates for MCS-assisted HR-PCI.
