Clinical trials of acute mechanical circulatory support in cardiogenic shock and high-risk percutaneous coronary intervention.

Abstract

Acute mechanical circulatory support devices have become widely used in cardiogenic shock and high-risk percutaneous coronary intervention (PCI) but there remains significant controversy over the evidence supporting their use and the specific roles of various devices. In this review, we summarize major recent studies and identify key areas of future investigation. In cardiogenic shock, uncontrolled single arm studies emphasizing early mechanical circulatory support (MCS) have showed promising results, but randomized trials have either been stopped prematurely or enrolled patients with advanced shock unlikely to benefit from MCS. In high-risk PCI, only one randomized controlled trail has been performed, with practice guided largely by observational data. Randomized trials of current-generation mechanical support devices incorporating contemporary best-practices and performed in clearly defined populations are badly needed to clarify the role of acute MCS devices in cardiogenic shock and high-risk PCI.