Impact of mechanical circulatory support modalities on outcomes in acute myocardial infarction-related cardiogenic shock undergoing early revascularization: A systematic review of survival and cardiac function outcomes

Introduction: Cardiogenic shock complicates 5–10% of acute myocardial infarctions and remains associated with early mortality of approximately 40%. Mechanical circulatory support devices, including intra-aortic balloon pump, Impella, and extracorporeal membrane oxygenation, are increasingly applied, yet their effect on outcomes is uncertain. Objectives: This review aimed to systematically evaluate the impact of intra-aortic balloon pump, Impella, and extracorporeal membrane oxygenation on survival and left ventricular function in patients with acute myocardial infarction complicated by cardiogenic shock undergoing early revascularization. Methods: A systematic search of PubMed, ScienceDirect, and the Cochrane Library was conducted up to May 1, 2025. Eligible studies included randomized controlled trials and observational studies assessing intra-aortic balloon pump, Impella, or extracorporeal membrane oxygenation in acute myocardial infarction–related cardiogenic shock. Two reviewers independently screened studies, extracted data, and assessed quality using Cochrane RoB 2.0 and ROBINS-I tools. Sixteen studies encompassing more than 35,000 patients were included. Results: Across all modalities, mechanical circulatory support did not consistently improve short- or long-term survival. Randomized trials showed no benefit for intra-aortic balloon pump in survival or ventricular recovery. Impella use was associated with higher rates of bleeding and vascular complications without mortality advantage. Extracorporeal membrane oxygenation demonstrated the highest complication rates. Early Impella deployment showed limited potential for ventricular recovery in select cases, but results were inconsistent. Conclusions: Despite theoretical hemodynamic benefits, current evidence does not demonstrate consistent improvements in survival or left ventricular function with intra-aortic balloon pump, Impella, or extracorporeal membrane oxygenation in acute myocardial infarction complicated by cardiogenic shock. High complication rates, particularly with Impella and extracorporeal membrane oxygenation, offset potential benefits, underscoring the need for timely revascularization rather than reliance on mechanical circulatory support.