Percutaneous mechanical support for cardiogenic shock complicating ACS

Cardiogenic shock (CS) complicating ACS remains a common and frequently fatal disorder. The presence of ischemic and/or stunned or hibernating myocardium may have a profound impact on the initial, in-hospital, and post-discharge management and prognosis. The invasive management of the complex cardiac patient with advanced heart failure, CS, and/or potential hemodynamic compromise during and after percutaneous coronary intervention (PCI) has become an element of specialized myocardial intervention centers. Such centers provide state-of-the-art facilities for PCI including experienced senior operators and critical care physicians who are available 24 h per day, 7 days per week, with immediate access to cardiac surgery and mechanical circulatory support (MCS) systems. In this article, we will discuss the invasive treatment of acute heart failure syndromes/CS complicating ACS, focusing on the implementation of percutaneous mechanical circulatory support.