Multidisciplinary Management and Hemodynamic Rescue of Cardiogenic Shock in RCA STEMI With Severe Mitral Regurgitation
Related Experiment Video
Updated: Mar 6, 2026

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
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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