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  • Editorial: Impact of Timing of Impella Support in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

    Cardiogenic shock develops in approximately 5% to 10% of patients with acute myocardial infarction (AMI)  . The rate of death remains obstinately high (approximately 40% to 60%) in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) despite prompt revascularization of the culprit vessel coupled with adjuvant pharmacological therapies [  ]. The landmark Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock [intra-aortic balloon pump (IABP)-Shock II] trial  showed no difference in 30-day mortality with hemodynamic support from aortic counterpulsation in comparison with optimal medical therapy among patients with AMICS. Consequently, the intersocietal recommendations for the use of IABP in the AMICS population have been downgraded in European and American guidelines  , with a resultant decrease in its clinical use. This has allowed the emergence of the alternative mechanical circulatory support (MCS) devices that provide superior hemodynamic support, with Impella (Abiomed, Danvers, Massachusetts, USA), which got approved by the United States Food and Drug Administration in 2008  , being one of the most commonly utilized devices for AMICS. Randomized studies comparing the IABP with Impella devices have not demonstrated improved survival with Impella  . However, these studies suffered from small sample sizes, poorly defined inclusion criteria, and weak study designs; therefore, their results should be interpreted with caution.

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