Mechanical circulatory support in acute myocardial infarction and cardiogenic shock: Challenges and importance of randomized control trials

Catheter Cardiovasc Interv. 2021 Dec 1;98(7):1264-1274. doi: 10.1002/ccd.29593. Epub 2021 Mar 7.

Abstract

Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is associated with significant morbidity and mortality.

Methods: We provide an overview of previously conducted studies on the use of mechanical circulatory support (MCS) devices in the treatment of AMI-CS and difficulties which may be encountered in conducting such trials in the United States.

Results: Well powered randomized control trials are difficult to conduct in a critically ill patient population due to physician preferences, perceived lack of equipoise and challenges obtaining informed consent.

Conclusions: With growth in utilization of MCS devices in patients with AMI-CS, efforts to perform well-powered, randomized control trials must be undertaken.

Keywords: ECMO/IABP/Tandem/Impella; acute myocardial infarction/STEMI; cardiogenic shock; clinical trials; mechanical circulatory support.

Publication types

  • Review

MeSH terms

  • Heart-Assist Devices*
  • Humans
  • Intra-Aortic Balloon Pumping
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / diagnosis
  • Myocardial Infarction* / therapy
  • Randomized Controlled Trials as Topic
  • Shock, Cardiogenic / diagnosis
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / therapy
  • Treatment Outcome
  • United States