{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T15:00:32Z","timestamp":1778857232389,"version":"3.51.4"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cardiogenic shock (CS) is a common sequitur in acute myocardial infarction (AMI), with significant associated mortality. Mechanical circulatory support (MCS) devices have been used in the management of AMI complicated by CS (AMICS). The relative safety and efficacy of these devices in this context is not yet fully established. Our aim is to provide an up-to-date analysis of outcomes to guide future clinical decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a frequentist network meta-analysis assessing mortality and complications associated with MCS devices, using exclusively randomized controlled trials (RCTs). The devices studied were intra-aortic balloon pump (IABP), Impella\u00ae, extracorporeal membrane oxygenation (ECMO), and TandemHeart\u00ae. A total of 18 RCTs were identified, with a combined patient population of 1907. Impella\u00ae reduced 6\u201312 month mortality vs. standard medical therapy [risk ratio (RR) 0.81, P &amp;lt; 0.05] but increased requirement for renal replacement therapy, limb complications, and major bleeding (RR, 1.6; P = 0.02; RR, 4.8; P = 0.02; and RR, 2.0; P = 0.004, respectively). No other form of MCS demonstrated a statistically significant mortality benefit when compared with medical therapy; however, ECMO increased vascular complications and major bleeding (RR, 3.1; P = 0.003 and RR, 2.4, P = 0.0001, respectively), and TandemHeart\u00ae increased limb complications (RR, 19; P = 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Impella\u00ae support in AMICS was associated with a long-term survival benefit. Impella\u00ae, ECMO, and TandemHeart\u00ae use were associated with increased morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf072","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T11:32:21Z","timestamp":1753788741000},"page":"1184-1195","source":"Crossref","is-referenced-by-count":3,"title":["Mechanical circulatory support devices vs. standard medical therapy for treatment of myocardial infarction complicated by cardiogenic shock: a network meta-analysis"],"prefix":"10.1093","volume":"11","author":[{"given":"Rosie","family":"Freer","sequence":"first","affiliation":[{"name":"St George\u2019s Hospital, St George\u2019s University Hospitals , Blackshaw Road, London SW17 0QT ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Frost","sequence":"additional","affiliation":[{"name":"St George\u2019s Hospital, St George\u2019s University Hospitals , Blackshaw Road, London SW17 0QT ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adithya","family":"Sreenivas","sequence":"additional","affiliation":[{"name":"University College London , Gower Street, London WC1E 6BT ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheref","family":"Zaghloul","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Berkshire Hospital Reading , London Road, ReadingRG1 5AN ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Bray","sequence":"additional","affiliation":[{"name":"University College London , Gower Street, London WC1E 6BT ,","place":["UK"]},{"name":"Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford University Hospitals , Oxford OX3 0AG ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9107-3704","authenticated-orcid":false,"given":"Mahmood","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Free Hospital , Pond Street, London NW3 2QG ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9141-9883","authenticated-orcid":false,"given":"Rui","family":"Provid\u00eancia","sequence":"additional","affiliation":[{"name":"University College London , Gower Street, London WC1E 6BT ,","place":["UK"]},{"name":"Barts Heart Centre, St Bartholomew's Hospital , W Smithfield, London EC1A 7EB ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"2025110923204228900_qcaf072-B1","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1161\/CIRCULATIONAHA.106.613596","article-title":"Cardiogenic shock: current concepts and improving outcomes","volume":"117","author":"Reynolds","year":"2008","journal-title":"Circulation"},{"key":"2025110923204228900_qcaf072-B2","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/S0735-1097(00)00879-2","article-title":"Cardiogenic shock complicating acute myocardial infarction\u2013etiologies, management and outcome: a report from the SHOCK trial registry. Should we emergently revascularize occluded coronaries for cardiogenic shock?","volume":"36","author":"Hochman","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2025110923204228900_qcaf072-B3","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1056\/NEJM199908263410901","article-title":"Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock","volume":"341","author":"Hochman","year":"1999","journal-title":"N Engl J Med"},{"key":"2025110923204228900_qcaf072-B4","doi-asserted-by":"crossref","first-page":"e000590","DOI":"10.1161\/JAHA.113.000590","article-title":"Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States","volume":"3","author":"Kolte","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"2025110923204228900_qcaf072-B5","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jcin.2015.10.039","article-title":"Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction: a report from the CathPCI registry","volume":"9","author":"Wayangankar","year":"2016","journal-title":"JACC Cardiovasc 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