Related Experiment Video

Updated: Aug 19, 2026

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
06:10

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

Association of Shock-to-Balloon Time With Outcomes in Acute Myocardial Infarction With Cardiogenic Shock Requiring

Onyou Kim1, Ji Hyun Cha2,3, Sang Yoon Lee2

  • 1From the Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|August 17, 2026
PubMed

Insights

For acute myocardial infarction with cardiogenic shock (AMI-CS) patients on VA-ECMO, a longer shock-to-balloon time (STB) increases mortality risk. Early revascularization is crucial for better outcomes in these critically ill patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Critical Care Medicine

Background:

  • Optimal timing for percutaneous coronary intervention (PCI) in acute myocardial infarction with cardiogenic shock (AMI-CS) patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO) is not well-defined.
  • Shock-to-balloon time (STB) is a critical metric in managing AMI-CS, but its prognostic value in the context of VA-ECMO support requires further investigation.

Purpose of the Study:

  • To evaluate the prognostic impact of shock-to-balloon time (STB) on mortality in patients with AMI-CS who are supported with VA-ECMO prior to revascularization.

Main Methods:

  • Pooled patient data from dedicated cardiogenic shock registries (SMART-RESCUE and SMC-ECMO) were analyzed.
  • A total of 256 patients were included and stratified based on STB: <120 minutes (n=140) and ≥120 minutes (n=116).
  • Statistical analysis, including adjusted hazard ratios (HR) and confidence intervals (CI), was used to assess mortality differences.

Main Results:

  • Patients with STB ≥120 minutes had significantly higher all-cause mortality (65.2%) compared to those with STB <120 minutes (44.6%; adjusted HR: 1.59, 95% CI: 1.03-2.45, p=0.037).
  • This association was significant in ST-segment elevation myocardial infarction (STEMI) subgroups (adjusted HR: 2.22) and in patients with earlier VA-ECMO initiation (<60 min; adjusted HR: 2.50).
  • A non-significant trend towards higher mortality was observed in the non-ST-segment elevation myocardial infarction (NSTEMI) subgroup with prolonged STB.

Conclusions:

  • In AMI-CS patients treated with VA-ECMO, a prolonged STB is associated with increased all-cause mortality.
  • STB serves as a valuable prognostic marker in this high-risk population.
  • These findings highlight the need for prospective evaluation of coordinated VA-ECMO and revascularization strategies to optimize patient outcomes.

Keywords:
acute myocardial infarctioncardiogenic shockextracorporeal membrane oxygenatorpercutaneous coronary interventionshock-to-balloon time

More Related Videos

Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock06:30

Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock

Published on: May 19, 2022

Related Concept Videos

Blood Pressure Imbalances and Circulatory Shock01:24

Blood Pressure Imbalances and Circulatory Shock

Disorders affecting blood volume, vascular tone, or vascular function can disrupt vascular homeostasis, including conditions like hypertension, hemorrhage, and shock.
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

Cardiopulmonary Resuscitation IV: Pharmacological Management

Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...