Finding Traction for Mechanical Circulatory Support During Coronary Interventions

The management of acute cardiogenic shock remains one of the great challenges of contemporary cardiovascular care. Cardiogenic shock manifests as a vicious cascade of systemic hypoperfusion leading to multi-organ system dysfunction and is a hallmark of severe ventricular failure in the wake of extensive myocardial damage following acute infarction. 1 Shock complicates between 5-8% of ST-segment elevation myocardial infarctions (STEMI) and 2-3% of non-STEMI. 2 More than 80% of the time, shock arises from direct myocardial injury downstream from an occluded artery, with the remaining cases coming from later mechanical complications such as acute mitral regurgitation or ventricular septal defect. Despite remarkable advances in medical therapy for acute coronary syndromes over the last three decades, especially the emphasis on early recognition and reperfusion therapy, cardiogenic shock remains a leading cause of death after STEMI and carries with it a mortality rate between 40-50%. 2, 3