{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:03:05Z","timestamp":1781002985338,"version":"3.54.1"},"reference-count":47,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Cardiogenic shock (CS) is the most lethal complication of acute myocardial infarction (AMI), with a 30-day mortality of approximately 40\u201350% despite early revascularization. Temporary mechanical circulatory support (tMCS) devices, including the intra-aortic balloon pump (IABP), microaxial flow pumps (MAFP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), are used as adjunctive therapy in refractory shock, but evidence of a survival benefit is limited and often conflicting. The IABP-SHOCK II trial found no 30-day mortality reduction with IABP, supporting a Class III (no benefit) recommendation, whereas the DanGer Shock trial reported a 12.7% absolute mortality reduction at 180 days with the MAFP Impella CP in highly selected patients. In contrast, the ECLS-SHOCK and ECMO-CS trials showed no improvement in survival with early VA-ECMO and noted high complication rates. Real-world data reveal significant disparities between trial populations and clinical practice, highlighting limitations of current evidence, since many AMI-CS patients are older, in more advanced shock or have multiple comorbidities and would not meet typical randomized controlled trial (RCT) inclusion criteria. In clinical practice, in-hospital mortality with IABP or VA-ECMO often exceeds 50\u201360%. Given the heterogeneity of AMI-CS, rapid identification of appropriate tMCS candidates and personalized therapy are essential. Management guided by individual patient profile, hemodynamic stage and neurological status, supported by multidisciplinary shock teams, may improve timely triage, device selection and outcomes. This review emphasizes the need for individualized, protocol-driven care within structured shock systems to optimize tMCS use in AMI-CS.<\/jats:p>","DOI":"10.3390\/jcm15124453","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:46:54Z","timestamp":1780998414000},"page":"4453","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mechanical Support in Myocardial Infarction Complicated by Cardiogenic Shock: What Have We Learned from Trials?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6391-422X","authenticated-orcid":false,"given":"Cristina","family":"Aurigemma","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0793-7923","authenticated-orcid":false,"given":"Norman","family":"Mangner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, 01307 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Panoulas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob Eifer","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1007\/s00134-018-5214-9","article-title":"Management of cardiogenic shock complicating myocardial infarction","volume":"44","author":"Mebazaa","year":"2018","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1001\/jama.2021.18323","article-title":"Cardiogenic shock after acute myocardial infarction: A review","volume":"326","author":"Samsky","year":"2021","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"34","DOI":"10.2174\/157340308783565456","article-title":"A review of cardiogenic shock in acute myocardial infarction","volume":"4","author":"Khalid","year":"2008","journal-title":"Curr. 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