Mechanical circulatory support in high-risk PCI and acute coronary syndrome

摘要

Acute myocardial infarction is a common cause of cardiogenic shock (approximately 75% of all patients) and out-of-hospital cardiac arrest (approximately 70% of survivors). 1 Mechanical hemodynamic support is employed prior to coronary revascularization (pre-percutaneous coronary intervention (PCI)), during or after PCI. 2 Revascularization procedure is characterized by a transient interruption of coronary blood flow (due to repetitive contrast dye injections, balloon inflations, atherectomy passes, and stent manipulations) resulting in a negative inotropic effect. Percutaneous left ventricular assist device implantation (Impella and TandemHeart), and intra-aortic balloon pump implantation have been described as strategies to avoid the worsening of cardiac function during PCI in the literature, especially in high-risk patients. The USpella registry has shown that pre-PCI implantation of IMPELLA 2.5 significantly improves survival of cardiogenic shock patients (Figure 1).