Related Experiment Video
Updated: Sep 20, 2026

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Routine microaxial left ventricular support during nonemergent high-risk PCI: an updated systematic review and
Ahmed Elmorsy Mohamed1, Mustafa Abomohsen1, Abdul Hakim Almakadma1
1Department of Internal Medicine, Brookdale University Hospital, NY, USA.
Introduction:
Microaxial left ventricular support (MLVS; Impella, Abiomed) is increasingly used during nonemergent high-risk percutaneous coronary intervention (HR-PCI), although randomized evidence remains limited and device-related complications are a concern.
Methods:
PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were searched from inception through March 2026 for randomized and comparative observational studies of MLVS versus control during nonemergent HR-PCI. Random-effects meta-analysis, subgroup and sensitivity analyses, Bayesian modeling, risk-of-bias assessment, and GRADE were performed.
Results:
Ten studies including 7,875 patients were analyzed. MLVS was not associated with lower all-cause mortality overall (RR 1.17, 95% CI 0.81-1.67; I2 = 82.1%). Exploratory analyses showed higher mortality estimates in randomized trials (RR 1.44, 95% CI 1.05-1.97) and studies of planned pre-PCI support (RR 1.52, 95% CI 1.17-1.97). Bayesian analysis yielded a median RR of 1.14 (95% CrI 0.80-1.65; Pr[RR > 1]=77.2%). Myocardial infarction, stroke/cerebrovascular events, and MACE/MACCE were not significantly different, while major bleeding was increased (RR 1.92, 95% CI 1.14-3.23).
Conclusions:
Current evidence does not support routine prophylactic MLVS during nonemergent HR-PCI. Selective use may remain appropriate, but further adequately powered randomized trials are needed.
Protocol Registration:
PROSPERO CRD420261358349.
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