The Role of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock-Part 1: Pathophysiology and Current Evidence.

Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) carries high mortality despite improvement in contemporary revascularization. The pathophysiology is complex, involving impaired left ventricular function, systemic inflammation, metabolic derangements, and mechanical complications, which often progress to multiorgan failure. Mechanical circulatory support (MCS) devices provide temporary hemodynamic stabilization by unloading the left ventricle and maintaining systemic perfusion, but their role remains debated. Landmark trials have shown no mortality benefit with MCS. This review summarizes the evolving evidence, guideline updates, and practical considerations for MCS use in AMI-CS, emphasizing the importance of patient selection, timing, and multidisciplinary management in optimizing outcomes.