A New Era of Coronary Interventional Therapy: Precision Revascularization Strategies and Evidence-Based Innovations in Critical-Care Mechanical Circulatory Support

Q: What is the clinical evidence from this study?

Study design: Review. Population: Coronary artery disease and acute myocardial infarction-related cardiogenic shock. Intervention: Precision revascularization (FFR, QFR, IVUS, OCT, DES, DCB) and mechanical circulatory support (microaxial flow pump, IABP, VA-ECMO) vs. Conventional angiography-guided PCI or standard medical care alone.

Q: What does this research mean for the field?

Physiology- and imaging-guided PCI reduce major adverse cardiovascular events, while microaxial flow pumps reduce 180-day mortality in STEMI cardiogenic shock. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Nan Qin; Jianhong Qin

doi:10.4236/abb.2026.1711039

January 1, 2026Advances in Bioscience and BiotechnologyOpen Access

A New Era of Coronary Interventional Therapy: Precision Revascularization Strategies and Evidence-Based Innovations in Critical-Care Mechanical Circulatory Support

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Why the study?

Despite advances in precision-oriented PCI for CAD, cardiogenic shock complicating AMI still carries mortality exceeding 40%, and considerable controversy persists regarding the selection of mechanical circulatory support strategies.

Key Points

To summarize contemporary advances in precision-oriented coronary interventional revascularization and evaluate evidence-based mechanical circulatory support strategies for acute myocardial infarction complicated by cardiogenic shock.
Conducted a narrative review of randomized controlled trials and clinical guidelines indexed in PubMed and guideline databases through 2025.
Synthesized evidence across physiology-guided revascularization, intracoronary imaging, stent optimization, and tailored antithrombotic regimens.
Evaluated clinical evidence for mechanical circulatory support devices, including intra-aortic balloon pumps, extracorporeal membrane oxygenation, and microaxial flow pumps.
Cardiogenic shock complicates 7% - 10% of acute myocardial infarction cases, with in-hospital mortality persistently exceeding 40%.
The DanGer Shock trial demonstrated that microaxial flow pumps combined with standard care reduced 180-day all-cause mortality in STEMI-related cardiogenic shock, upgrading device recommendations from Class IIb to IIa.
Routine intra-aortic balloon pump use has been guideline-downgraded, and findings from ECLS-SHOCK prompted US guidelines to downgrade extracorporeal membrane oxygenation to a Class III recommendation in this population.

Structured PICO

P

Population

Patients with coronary artery disease undergoing percutaneous coronary intervention or experiencing acute myocardial infarction-related cardiogenic shock across contemporary randomized trials and registries.

I

Intervention

Precision-oriented PCI strategies (physiology-guided PCI via FFR and QFR, intracoronary-imaging-guided PCI via IVUS and OCT, drug-eluting stents, drug-coated balloons, chronic total occlusion interventions), mechanical circulatory support (IABP, VA-ECMO, microaxial flow pump), and individualized antithrombotic therapy (dual antiplatelet therapy and periprocedural anticoagulation)

This narrative review synthesizes contemporary evidence supporting the transition to physiology- and imaging-guided precision PCI, stratified antithrombotic therapy, and the selective use of microaxial flow pumps over routine IABP or ECMO in AMI-related cardiogenic shock.

Limitations

Narrative review design that does not adhere to a predefined systematic search protocol or formal inclusion/exclusion criteria
Heterogeneous cardiogenic shock populations across trials with varying aetiologies and severities
Restricted trial eligibility criteria that may not reflect real-world clinical practice
Limited randomized evidence specifically addressing combined mechanical circulatory support strategies
As a narrative review, this article does not adhere to a predefined systematic search protocol or inclusion/exclusion criteria.
The evidence base for interventional strategies in cardiogenic shock is limited by heterogeneous shock populations with varying aetiologies and severities.
Restricted trial eligibility criteria may not reflect real-world clinical practice.
Limited randomized evidence specifically addressing combined circulatory support strategies.

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Answers are grounded in this paper and cite their sources.

Implication

May support guided PCI and microaxial pumps in shock; leaves open confirmation in prospective RCTs.

Abstract

Over the past two decades, percutaneous coronary intervention (PCI) for coronary artery disease (CAD) has undergone a precision-oriented transformation from anatomy-guided to physiology- and intracoronary-imaging-guided practice. Iterative application of drug-eluting stents (DES) and drug-coated balloons (DCB) has substantially improved clinical outcomes. Nevertheless, cardiogenic shock complicating acute myocardial infarction (AMI) remains the most lethal complication of CAD, with persistently high mortality exceeding 40%. To date, considerable controversy persists regarding the selection of mechanical circulatory support (MCS) strategies. This narrative review summarizes advances in precision-oriented interventional strategies for CAD, covering fractional flow reserve (FFR)- and quantitative flow ratio (QFR)-guided PCI, stent optimization guided by intravascular ultrasound (IVUS) and optical coherence tomography (OCT), synergistic use of DES and DCB, and interventional breakthroughs for chronic total occlusion (CTO). On this basis, it analyzes MCS strategies for cardiogenic shock, compares clinical evidence for intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO) and microaxial flow pump, and discusses prospects for combined circulatory support regimens. This paper also reviews individualized decision-making for dual antiplatelet therapy (DAPT) duration and Chinese original evidence for periprocedural anticoagulation, aiming to provide evidence-based references for precision intervention and critical-care management of CAD.

Discussion

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Cite This Study

Qin et al. (2026) conducted a review in Coronary artery disease and acute myocardial infarction-related cardiogenic shock. Precision revascularization (FFR, QFR, IVUS, OCT, DES, DCB) and mechanical circulatory support (microaxial flow pump, IABP, VA-ECMO) vs. Conventional angiography-guided PCI or standard medical care alone was evaluated.

synapsesocial.com/papers/6af5cd26a40bbe8669e89ba1 https://doi.org/10.4236/abb.2026.1711039

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A New Era of Coronary Interventional Therapy: Precision Revascularization Strategies and Evidence-Based Innovations in Critical-Care Mechanical Circulatory Support

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A New Era of Coronary Interventional Therapy: Precision Revascularization Strategies and Evidence-Based Innovations in Critical-Care Mechanical Circulatory Support

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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