Percutaneous transvalvular microaxial flow pump is underused in infarct-related cardiogenic shock: pros and cons

ST-segment elevation myocardial infarction (STEMI) is complicated by its most severe manifestation, CS, in up to 10% of cases 1 .For decades, the mortality rate in patients with STEMI and CS has plateaued at approximately 50%, despite several attempts to improve survival 1 .In 1999, the SHOCK Trial demonstrated a 6-month survival benefit of acute percutaneous coronary intervention (PCI) in patients with STEMI complicated by CS 2 .Since then, there has been a lack of breakthrough treatments, and the results of subsequent randomised clinical trials have been disappointing 2 .CS is characterised by the hypoperfusion of vital organs due to the severe reduction in cardiac output that is caused by myocardial injury.Therefore, recent attempts to improve the survival of patients with STEMI complicated by CS have focused on percutaneous mechanical circulatory support (MCS) 2 .These include both complete haemodynamic support with VA-ECMO 3 and partial haemodynamic support by unloading the left ventricle using implantation of an intra-aortic balloon pump (IABP) or microaxial left