Mechanical circulatory support in acute myocardial infarction cardiogenic shock: a systematic review and meta-analysis of mortality and safety outcomes

RegistrationMechanical Circulatory Support (MCS) devices in acute myocardial infarction (AMI)-induced cardiogenic shock remain of uncertain mortality benefit with increasing safety concerns. Therefore, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of MCS compared to medical therapy in AMI-induced cardiogenic shock. Following PRISMA guidelines, four databases were searched for studies published in English up to January 12, 2025, that evaluated the clinical outcomes of MCS devices, including Intra-Aortic Balloon Pump (IABP), Impella, or Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO), compared to conventional therapy. Data were pooled using random-effect models. The primary outcome was all-cause mortality, while the secondary outcomes included major bleeding and vascular complications. Heterogeneity across studies was assessed using the Q test and I 2 , with I 2 > 50% indicating substantial heterogeneity. A total of 32 studies with 38 comparisons were included ( IABP : n = 27, 131553 participants; Impella : n = 6, 56588 participants; ECMO : n = 5, 63848 participants). MCS resulted in similar all-cause mortality across devices compared with conventional therapy [ IABP : OR = 1.00 (95% CI: 0.85–1.18, I 2 96.1%); Impella : OR = 1.01 (95% CI: 0.64–1.57, I 2 97.47%); ECMO : OR = 1.1 (95% CI: 0.73–1.66, I 2 95.32%), and was judged to have low and very low certainty of evidence from randomized controlled trial (RCT) and cohort studies, respectively. Major bleeding was significantly increased with all devices, while vascular complications were higher with Impella and ECMO. This comprehensive meta-analysis found that MCS devices were not associated with a statistically significant reduction in mortality compared with conventional therapy. However, MCS use was associated with increased major bleeding and vascular complication rates, particularly with Impella and ECMO use, warranting more research for the selective and evidence-based MCS use in this population. Given the low to very low certainty of the available evidence and considerable heterogeneity, these findings should be interpreted with caution and confirmed in RCTs. Registration The protocol of the systematic review and metaanalysis was registered in PROSPERO (CRD420250622111).