• Lauren Truby, Yoshifumi Naka, Bindu Kalesan, Takeyoshi Ota, Ajay J Kirtane, Susheel Kodali, Natasha Nikic, Lily Mundy, Paolo Colombo, Ulrich P Jorde, and Hiroo Takayama.
• Department of Surgery, Columbia University Medical Center, New York, NY, USA.
• Eur J Cardiothorac Surg. 2015 Aug 1; 48 (2): 322-8.

ObjectivesAcute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with significant mortality despite the widespread application of early revascularization strategies. Recent evidence suggests that the use of intra-aortic balloon pump (IABP) counterpulsation does not improve mortality in this cohort of patients. We summarize our experience with mechanical circulatory support (MCS) therapy for AMI/CS.MethodsThis is a retrospective review of 61 patients who received MCS therapy for AMI/CS at our institution between March 2007 and March 2013.ResultsMean age was 60.2 ± 10.3 years; mean ejection fraction was 24 ± 15% and 29% of patients were receiving active cardiopulmonary resuscitation at the time of support initiation. Prior to the initiation of MCS, 70.5% of patients had an IABP. Mean arterial pressure improved significantly with MCS (63 mmHg prior to MCS, 82 mmHg after MCS, P ≤ 0.01). Mean length of support was 9.5 ± 11.0 days, and overall survival to 30 days was 59.0%. Among 30-day survivors, 44.4% required device exchange to a durable MCS device. Ultimately, only 31% (52.8% of patients who survived to 30 days) achieved myocardial recovery.ConclusionsShort-term MCS therapy with subsequent aggressive use of durable MCS device may improve the unacceptably high mortality rate in AMI/CS. Rigorous prospective studies of MCS therapy in AMI/CS are warranted.© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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