What are the 2015 SCAI/ACC/HFSA/STS guidelines for mechanical circulatory support (MCS) devices in the treatment of myocardial infarction (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Answer

In a 2015 clinical expert consensus statement by the SCAI/ACC/HFSA/STS noted that historically the intraaortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) devices had been the only MCS devices available to clinicians, but axial flow pumps, such as Impella and left atrial to femoral artery bypass pumps, such the TandemHeart have more recently entered clinical practice. The consensus-based recommendations included the following [132] :

  • Percutaneous circulatory assist devices provide superior hemodynamic support compared with pharmacologic therapy, which is particularly apparent for the Impella and Tandem-Heart devices.
  • In those with cardiogenic shock who fail to stabilize or show signs of improvement after initial interventions, consider early placement of an appropriate MCS.
  • In patients with cardiogenic shock, continuous flow pumps (eg, Impella CP, TandemHeart) are more likely to provide clinical benefit than IABP. ECMO may provide particular benefit for patients with impaired respiratory gas exchange.
  • Consider MCS for isolated acute right ventricular failure that is complicated by cardiogenic shock.
  • Consider MCS in the setting of high-risk percutaneous coronary intervention (PCI) (eg, multivessel, left main, or last patent conduit interventions), particularly if the patient is inoperable or has severely decreased ejection fraction or elevated cardiac filling pressures.
  • Consider MCS in patients who fail to wean off of cardiopulmonary bypass.
  • Consider early MCS in patients with acute decompensated heart failure who continue to deteriorate despite initial interventions.
  • MCS may be necessary in the setting of severe biventricular failure via both right- and left-sided percutaneous devices or venoarterial ECMO.

However, there was insufficient evidence regarding the routine use of MCS as an adjunct to primary revascularization to reduce reperfusion injury or infarct size in patients with large acute MI. [132]


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