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Updated: Mar 6, 2026

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Multidisciplinary Management and Hemodynamic Rescue of Cardiogenic Shock in RCA STEMI With Severe Mitral
Afek Kodesh1, Ivan Aivasovsky1, Matteo Sturla1
1Department of Internal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
Clinical Condition:
A 55-year-old man was admitted with inferior-wall ST-segment elevation myocardial infarction. He was found to have multivessel disease with a culprit lesion not amenable for revascularization, new ischemic mitral regurgitation, and cardiogenic shock, prompting the initiation of mechanical circulatory support (MCS). His course was complicated by conduction abnormalities.
Key Questions:
Some questions for consideration were: 1) Which criteria guide the choice of MCS in patients with complex cardiovascular anatomy and cardiogenic shock? 2) Is coronary artery bypass grafting with concomitant mitral valve repair/replacement superior to percutaneous coronary intervention and mitral transcatheter edge-to-edge repair in patients with poor target vessels and severe mitral regurgitation?
Outcome:
After initial stabilization with intra-aortic balloon pump, the patient underwent staged percutaneous coronary intervention and mitral transcatheter edge-to-edge repair, leading to resolution of symptoms and disease. He also received a prophylactic implantable cardioverter-defibrillator in the setting of variable block and reduced left ventricular ejection fraction.
Take-Home Message:
This case highlights the importance of multidisciplinary discussions for a patient with complex cardiovascular anatomy requiring MCS and a high level of acute care.
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