Cardiac Assist Devices in Cardiogenic Shock: What You See Is What you get?

Emmanouil Poulidakis, MD; Christian Spaulding, MD, PhD


Circulation. 2019;139(10):1259-1261. 

In This Article

Abstract and Introduction


Those who cannot remember the past are condemned to repeat it.
—George Santayana [1]

The practice of interventional cardiology is a daily source of instant gratification: identify a critical coronary lesion, implant a stent, and obtain a pristine result. The use of an Impella device in cardiogenic shock is on the top of this satisfaction list: a patient with an acute myocardial infarction (AMI) complicated by cardiogenic shock (AMI-CS), confused and crashing with low systolic blood pressure, is rushed into the catheritization laboratory, an Impella CP is implanted in 10 minutes flat, the start button is pushed, the blood pressure rises, the patient regains consciousness, and percutaneous coronary intervention (PCI) is performed swiftly. The patient leaves the laboratory with an interventional cardiologist feeling on the top of the world that he has chosen the best therapeutic option. But what is the evidence supporting such practice? To date, there is no large randomized study comparing the use of Impella CP or other contemporary cardiac support devices and medical treatment in ST-segment–elevation myocardial infarction–related cardiogenic shock.