Cardiogenic shock surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Syed Musadiq Ali M.B.B.S.[3] James Nasr[4]

Cardiogenic shock surgery

Overview

Surgical and procedural therapy for cardiogenic shock includes emergency coronary revascularization, repair of mechanical complications of acute myocardial infarction, temporary mechanical circulatory support, and transition to durable mechanical circulatory support or heart transplantation in selected patients. Pharmacologic therapy, vasoactive drug selection, volume management, and detailed hemodynamic monitoring are addressed in the medical therapy and other diagnostic studies microchapters.[1][2][3]

Procedural decisions should be individualized according to shock etiology, SCAI stage, neurologic prognosis, right- versus left-sided failure, respiratory failure, coronary anatomy, mechanical complications, vascular access, institutional expertise, and a defined exit strategy.

Emergency coronary revascularization

Guideline recommendations

The 2025 ACC/AHA/ACEP/NAEMSP/SCAI acute coronary syndromes guideline gives emergency revascularization of the culprit vessel by percutaneous coronary intervention or coronary artery bypass grafting a class 1, level B-R recommendation in patients with acute coronary syndrome and cardiogenic shock or hemodynamic instability, irrespective of time from symptom onset.[1]

The SHOCK trial established the survival benefit of early revascularization compared with initial medical stabilization in acute myocardial infarction complicated by cardiogenic shock. Although 30-day mortality was not significantly reduced, mortality was lower at 6 months and the benefit persisted through long-term follow-up.[4][2]

Percutaneous coronary intervention

Culprit-vessel PCI is the most common emergency revascularization approach in acute myocardial infarction-related cardiogenic shock. It should be performed as soon as feasible when acute coronary occlusion is suspected and coronary anatomy is suitable.[1]

In patients with infarct-related cardiogenic shock and multivessel coronary artery disease, culprit-lesion-only PCI with an option for staged revascularization is preferred over routine immediate multivessel PCI. In the CULPRIT-SHOCK trial, the 30-day composite of death or renal replacement therapy occurred in 45.9% of the culprit-lesion-only group and 55.4% of the immediate multivessel PCI group (RR 0.83; 95% CI 0.71-0.96; P=0.01).[5]

At 1 year, mortality did not differ significantly between groups (50.0% vs 56.9%; RR 0.88; 95% CI 0.76-1.01), although the composite of death or renal replacement therapy remained significantly lower with culprit-lesion-only PCI. Repeat revascularization was substantially higher with culprit-lesion-only PCI (32.3% vs 9.4%), and rehospitalization for heart failure was also higher (5.2% vs 1.2%). A landmark analysis showed that the mortality benefit was confined to the first 30 days, with curves running approximately parallel thereafter.[6]

The 2025 acute coronary syndromes guideline gives routine PCI of a non-infarct-related artery during primary PCI a class 3: Harm, level B-R recommendation in cardiogenic shock.[1]

Coronary artery bypass grafting

Emergency CABG is appropriate when PCI is not feasible, PCI is unsuccessful, the culprit lesion cannot be treated percutaneously, or coronary anatomy favors surgical revascularization. CABG may also be required with mechanical complications requiring operative repair.[1][4]

The use of early CABG in cardiogenic shock has declined substantially compared with older trials. In the SHOCK trial, 36% of patients assigned to emergency revascularization underwent CABG, whereas more recent trials and registries report early CABG in fewer than 5% of patients.[4][3]

A hybrid strategy may be considered in selected patients, such as culprit-vessel PCI followed by staged CABG for residual complex multivessel disease, especially when diabetes, left main disease, or complex coronary anatomy favors surgical revascularization.[4]

Fibrinolytic therapy

When PCI or CABG cannot be performed in STEMI-related cardiogenic shock and there are no contraindications, fibrinolytic therapy is indicated. A pharmacoinvasive approach may be considered when transport delays to PCI-capable care are prolonged.[1][2]

Mechanical complications of acute myocardial infarction

General principles

Mechanical complications of acute myocardial infarction require immediate Heart Team evaluation. The 2025 acute coronary syndromes guideline states that patients with mechanical complications of ACS should be managed in a facility with cardiac surgical expertise and that short-term mechanical circulatory support is reasonable for hemodynamic stabilization as a bridge to surgery.[1]

Medical therapy alone is associated with high early mortality. Definitive correction is usually surgical, although selected patients may undergo percutaneous repair, temporary mechanical circulatory support as a bridge to intervention, durable mechanical circulatory support, heart transplantation, or palliative care depending on anatomy, shock severity, neurologic prognosis, comorbidity, and institutional expertise.[7]

Complication Definitive intervention Bridge or adjunctive strategy Key procedural considerations
Ventricular septal rupture Surgical patch repair; percutaneous closure in selected anatomy or prohibitive surgical risk IABP, Impella, or VA-ECMO in selected patients as bridge to repair Timing is controversial; delayed repair may have lower observed mortality but is affected by survivor and selection bias.[8][9]
Papillary muscle rupture with acute severe mitral regurgitation Urgent mitral valve surgery, usually chordal-sparing mitral valve replacement; repair in selected partial rupture Temporary MCS, afterload support, ventilatory support, and Heart Team evaluation TEE is often needed for diagnosis and operative planning. Concomitant CABG should be considered when obstructive coronary disease is present.[10]
Left ventricular free wall rupture Emergency surgical repair Emergency pericardiocentesis may temporize tamponade when surgery is not immediately available; VA-ECMO may stabilize selected patients Pericardiocentesis may fail when the pericardial space contains clot. Surgical techniques include sutured and sutureless repair.[11]
Left ventricular pseudoaneurysm Surgical repair is generally recommended Percutaneous closure may be considered in selected inoperable or high-risk patients Represents contained rupture with unpredictable risk of complete rupture.[11]

Ventricular septal rupture

Surgical repair remains the standard definitive therapy for post-myocardial infarction ventricular septal rupture. Common techniques include infarct excision, infarct exclusion, and patch-based repair. In a meta-analysis of 6,361 patients from 41 studies, overall operative mortality was 38.2%, with no clear improvement between 1971-2000 and 2001-2018.[8]

Timing remains controversial. In a study of 2,876 patients, 30-day mortality was lower when repair was delayed beyond 7 days than when repair occurred within 7 days, but delayed repair is strongly influenced by survivor bias because the sickest patients may not survive to delayed surgery.[12]

Percutaneous closure with occluder devices may be considered for prohibitive surgical risk, favorable anatomy, residual post-surgical shunts, or as a bridge to surgery. Reported procedural success may be high in experienced centers, but mortality remains substantial and complications include residual shunt, hemolysis, arrhythmia, device embolization, and need for repeat intervention.[8][9]

Papillary muscle rupture and acute severe mitral regurgitation

Complete papillary muscle rupture with acute severe mitral regurgitation usually requires emergency mitral valve replacement. Chordal-sparing replacement is often preferred because of reliability in unstable patients. Mitral valve repair may be considered in selected patients with partial papillary muscle rupture, favorable anatomy, and experienced surgical teams.[10]

In the SHOCK trial registry, only 38% of patients with acute myocardial infarction complicated by cardiogenic shock due to acute severe mitral regurgitation were offered mitral valve surgery. Observational data suggest surgery improves survival compared with medical therapy alone, despite high perioperative risk.[13][10]

Transcatheter edge-to-edge repair may be considered in selected prohibitive-risk patients after Heart Team evaluation. Registry data suggest that patients receiving surgical or percutaneous mitral intervention after myocardial infarction have lower mortality than conservatively managed patients, but selection bias limits causal interpretation.[14]

Free wall rupture and pseudoaneurysm

Free wall rupture commonly presents as sudden cardiac death or tamponade. Surgical repair is the only definitive therapy for patients who reach hospital alive. Contemporary reports describe in-hospital mortality of approximately 31% to 36% among surgically treated patients.[11][15]

Sutured and sutureless repair techniques are used. Sutured repair may be associated with more postoperative bleeding, whereas sutureless repair may be associated with higher recurrent rupture risk.[11]

Left ventricular pseudoaneurysm is a contained rupture. Surgical repair is generally recommended because of the risk of complete rupture, while percutaneous closure may be considered in selected inoperable or high-risk patients.[11]

Temporary mechanical circulatory support

Guideline recommendations

The 2025 acute coronary syndromes guideline provides the following short-term mechanical circulatory support recommendations in acute myocardial infarction-related cardiogenic shock and mechanical complications:[1]

Recommendation Class Level of evidence
In selected patients with STEMI and severe or refractory cardiogenic shock, insertion of a microaxial intravascular flow pump is reasonable to reduce death. 2a B-R
In patients with mechanical complications of ACS, short-term mechanical circulatory support devices are reasonable for hemodynamic stabilization as a bridge to surgery. 2a B-NR
In patients with acute myocardial infarction and cardiogenic shock, routine use of IABP or VA-ECMO is not recommended due to lack of survival benefit. 3: No benefit B-R

The 2022 AHA/ACC/HFSA heart failure guideline gives temporary mechanical circulatory support a class 2a, level B-NR recommendation when end-organ function cannot be maintained by pharmacologic means.[16]

Key randomized evidence

Trial Device or strategy Population Key finding
IABP-SHOCK II Intra-aortic balloon pump AMI-related cardiogenic shock undergoing early revascularization 30-day all-cause mortality was 39.7% vs 41.3% (P=0.69); no benefit was observed at 6 years.[17]
ECLS-SHOCK Early VA-ECMO strategy AMI-related cardiogenic shock with planned early revascularization 30-day all-cause mortality was 47.8% vs 49.0% (RR 0.98; 95% CI 0.80-1.19; P=0.81); moderate/severe bleeding and peripheral vascular complications were higher with ECLS.[18]
DanGer Shock Impella CP microaxial flow pump Selected STEMI-related cardiogenic shock without anoxic brain injury at experienced centers 180-day mortality was 45.8% vs 58.5% (HR 0.74; 95% CI 0.55-0.99; P=0.04). Composite safety endpoint events occurred in 24.0% vs 6.2%; moderate/severe bleeding occurred in 21.8% vs 11.9%; limb ischemia occurred in 5.6% vs 1.1%; renal replacement therapy occurred in 41.9% vs 26.7%.[19]
Altshock-2 Early intra-aortic balloon support Heart failure-related cardiogenic shock, SCAI stages B-D Early IABP did not improve survival or successful bridge at 60 days compared with standard care.[20]

Long-term follow-up of the DanGer Shock trial reported that the survival benefit of the microaxial flow pump persisted up to 10 years despite device-related complications.[21]

An individual patient data meta-analysis of randomized tMCS trials with 6-month follow-up suggested that patients with STEMI-related cardiogenic shock without risk of hypoxic brain injury had reduced mortality after tMCS use, inclusive of VA-ECMO. This finding provides broader context for the DanGer Shock result but does not support routine device use in all cardiogenic shock phenotypes.[22]

DanGer Shock applicability

DanGer Shock enrolled a selected population with STEMI-related cardiogenic shock, hypotension or vasopressor requirement, lactate elevation, no comatose state after cardiac arrest, and enrollment within 24 hours at experienced centers. These criteria limit direct extrapolation to NSTEMI-related shock, heart failure-related shock, severe neurologic injury after cardiac arrest, and lower-volume centers.[19][23]

In a Japanese nationwide registry of 3,975 AMI-related cardiogenic shock patients treated with Impella, only 35.6% met DanGer Shock eligibility criteria, highlighting the need for individualized risk assessment before applying trial results broadly.[24]

A DanGer Shock substudy found that immediate multivessel PCI was associated with lower odds of all-cause mortality compared with culprit-only PCI in the DanGer Shock population (adjusted OR 0.40; 95% CI 0.19-0.83). This exploratory, as-treated analysis should be interpreted cautiously, but it raises the hypothesis that adequate hemodynamic support may change the risk-benefit balance of multivessel PCI in selected Impella-supported patients.[25]

The greatest apparent benefit of microaxial flow pump support may vary by shock phenotype. A secondary analysis of DanGer Shock reported heterogeneous outcomes across phenotypes, with the cardiometabolic phenotype having the worst outcomes and apparent treatment effects differing by phenotype.[26]

Device selection by phenotype

Device choice should be guided by shock phenotype, respiratory failure, vascular access, need for LV unloading, RV failure, anticipated duration of support, complication risk, local expertise, and exit strategy.[23][27]

Phenotype or scenario Procedural support considerations
LV-dominant shock Microaxial LV pump, selected IABP use, or VA-ECMO with LV unloading strategy when needed
RV-dominant shock RV support such as Impella RP, ProtekDuo, or surgical RVAD in selected patients
Biventricular shock VA-ECMO, biventricular percutaneous support, or surgical BiVAD depending on oxygenation and anatomy
Shock with severe respiratory failure VA-ECMO may provide both circulatory and respiratory support. When VA-ECMO is used, LV unloading with a microaxial flow pump, sometimes termed an ECPELLA strategy, may be considered to reduce LV distension, improve myocardial recovery, and facilitate weaning.
Mechanical complications Short-term MCS may be used as a bridge to surgical or percutaneous repair
Bridge to durable therapy Temporary support may serve as bridge to durable LVAD, transplant, decision, candidacy, recovery, or palliation

In a propensity-matched multicenter cohort of 510 patients, LV unloading during VA-ECMO was associated with lower 30-day mortality (HR 0.79; 95% CI 0.63-0.98; P=0.03), although severe bleeding, limb ischemia, and renal replacement therapy were more frequent. Randomized data are needed to confirm whether ECPELLA improves outcomes and to define patient selection.[28]

Complications

Temporary mechanical circulatory support complications include bleeding, limb ischemia, vascular injury, hemolysis, thrombocytopenia, acquired von Willebrand syndrome, stroke, infection, device malposition, differential hypoxemia with peripheral VA-ECMO, LV distension during VA-ECMO, and device failure. Complication risk should be weighed against expected benefit and exit strategy before device placement.[27][19][18]

Areas of uncertainty and evolving evidence

  • The 2025 ACS guideline recommends against routine non-infarct-artery PCI during primary PCI for AMI-related cardiogenic shock, based largely on CULPRIT-SHOCK. However, exploratory DanGer Shock data raise the hypothesis that the risk-benefit balance of multivessel PCI may differ in selected Impella-supported STEMI-related cardiogenic shock patients.[1][25]
  • ECPELLA may reduce LV distension during VA-ECMO, but available supportive data are observational and accompanied by higher complication rates.[28]
  • Optimal timing of VSR repair remains unresolved because delayed surgery may reflect selection of patients stable enough to survive to delayed repair.[8][12]
  • The generalizability of DanGer Shock to NSTEMI-related shock, heart failure-related shock, post-cardiac arrest coma, and lower-volume centers remains uncertain.[19][24]

Durable mechanical circulatory support and heart transplantation

Patients with refractory cardiogenic shock who cannot be weaned from temporary support or vasoactive drugs should be evaluated early for durable LVAD, heart transplantation, or palliative goals of care. Evaluation should occur before irreversible multiorgan failure develops.[29][30]

Durable LVAD may be used as bridge to transplant, bridge to candidacy or decision, bridge to recovery, or destination therapy. The HeartMate 3 device demonstrated approximately 80% survival at 2 years and nearly 60% survival at 5 years in the MOMENTUM 3 experience. Outcomes are worse when durable LVAD is implanted after temporary MCS or advanced shock compared with elective implantation.[29]

Heart transplantation may be considered for selected patients with irreversible advanced heart failure, refractory shock, or biventricular failure. Donor availability, acute comorbidities, neurologic prognosis, age, frailty, infection, end-organ injury, and sensitization constrain transplant feasibility in the acute setting.[29][30]

Multidisciplinary shock team

The 2022 AHA/ACC/HFSA guideline gives management by a multidisciplinary team experienced in shock a class 2a, level B-NR recommendation.[16] The 2025 ACC Expert Consensus Statement supports standardized interdisciplinary management involving critical care cardiology, advanced heart failure, interventional cardiology, cardiac surgery, perfusion, and palliative care when appropriate.[23]

Shock teams facilitate:

  • Rapid diagnostic and hemodynamic phenotyping
  • Selection and timing of PCI, CABG, surgery, or percutaneous structural intervention
  • Device selection for temporary mechanical circulatory support
  • Transfer to advanced shock, durable MCS, or transplant centers
  • Bridge-to-recovery, bridge-to-decision, bridge-to-transplant, bridge-to-durable-MCS, or palliative exit strategy planning
  • Shared decision-making with patients and families

Practical procedural approach

  1. Activate a multidisciplinary shock team early in severe, refractory, mechanically supported, or phenotypically unclear cardiogenic shock.
  2. Perform emergency culprit-vessel revascularization in ACS-related cardiogenic shock when feasible.
  3. Avoid routine immediate multivessel PCI during primary PCI for AMI-related cardiogenic shock; recognize that Impella-supported multivessel PCI remains an evolving evidence area.
  4. Consider CABG when PCI is not feasible, PCI fails, coronary anatomy favors surgery, or operative repair of a mechanical complication is required.
  5. Evaluate immediately for mechanical complications when shock is disproportionate, new murmur is present, pulmonary edema is severe, or hemodynamics deteriorate after myocardial infarction.
  6. Use temporary mechanical circulatory support selectively based on shock phenotype, severity, oxygenation, complication risk, institutional expertise, and exit strategy.
  7. Consider LV unloading when VA-ECMO is used and LV distension, poor aortic valve opening, pulmonary edema, or inadequate myocardial recovery is present.
  8. Use short-term MCS as a bridge to surgical or percutaneous repair in selected patients with mechanical complications.
  9. Consider durable LVAD or heart transplantation early when recovery is unlikely and end-organ injury is potentially reversible.
  10. Incorporate palliative care when invasive treatment is nonbeneficial, inconsistent with patient goals, or unlikely to achieve meaningful recovery.

Common pitfalls

  • Delaying culprit-vessel revascularization in ACS-related cardiogenic shock
  • Performing routine immediate multivessel PCI in AMI-related cardiogenic shock outside selected individualized contexts
  • Treating post-MI mechanical complications medically without urgent surgical or Heart Team evaluation
  • Assuming delayed VSR repair is always preferable without accounting for instability and survivor bias
  • Applying DanGer Shock results to all cardiogenic shock phenotypes regardless of eligibility, neurologic status, or center experience
  • Using routine IABP or routine VA-ECMO in AMI-related cardiogenic shock without individualized indication
  • Starting VA-ECMO without planning LV unloading when LV distension risk is high
  • Choosing tMCS without defining an exit strategy
  • Delaying durable MCS or transplant evaluation until irreversible end-organ failure develops
  • Failing to discuss goals of care when prognosis is poor or invasive therapy is unlikely to achieve recovery

Historical note: The following 2004 ACC/AHA guideline recommendations are retained for historical reference only because this legacy source section is marked "DO NOT EDIT." They have been superseded by contemporary guideline recommendations. Key changes include: routine IABP use in AMI-related cardiogenic shock is now classified as no benefit; routine immediate multivessel PCI is classified as harm; selected microaxial flow pump use is reasonable in STEMI with severe or refractory cardiogenic shock; and routine VA-ECMO use is not recommended due to lack of survival benefit.[1]

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (DO NOT EDIT)[31]

Class I
"1. Intra-aortic balloon counterpulsation is recommended for STEMI patients when cardiogenic shock is not quickly reversed with pharmacological therapy. The IABP is a stabilizing measure for angiography and prompt revascularization. (Level of Evidence: B)"
"2. Intra-arterial monitoring is recommended for the management of STEMI patients with cardiogenic shock. (Level of Evidence: C)"
"3. Early revascularization, either PCI or CABG, is recommended for patients less than 75 years old with ST elevation or LBBB who develop shock within 36 hours of MI and who are suitable for revascularization that can be performed within 18 hours of shock unless further support is futile because of the patient’s wishes or contraindications/unsuitability for further invasive care. (Level of Evidence: A)"
"4. Fibrinolytic therapy should be administered to STEMI patients with cardiogenic shock who are unsuitable for further invasive care and do not have contraindications to fibrinolysis. (Level of Evidence: B)"
"5. Echocardiography should be used to evaluate mechanical complications unless these are assessed by invasive measures. (Level of Evidence: C)"
Class IIa
"1. Pulmonary artery catheter monitoring can be useful for the management of STEMI patients with cardiogenic shock. (Level of Evidence: C)"
"2. Early revascularization, either PCI or CABG, is reasonable for selected patients 75 years or older with ST elevation or LBBB who develop shock within 36 hours of MI and who are suitable for revascularization that can be performed within 18 hours of shock. Patients with good prior functional status who agree to invasive care may be selected for such an invasive strategy. (Level of Evidence: B)"

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 Rao SV, O'Donoghue ML, Ruel M; et al. (2025). "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes". Journal of the American College of Cardiology. doi:10.1016/j.jacc.2024.11.009.
  2. ↑ 2.0 2.1 2.2 Thiele H, Hassager C (2026). "Cardiogenic Shock". The New England Journal of Medicine. 394 (1): 62–77. doi:10.1056/NEJMra2312086.
  3. ↑ 3.0 3.1 Lüsebrink E, Binzenhöfer L, Adamo M; et al. (2024). "Cardiogenic Shock". Lancet. 404 (10466): 2006–2020. doi:10.1016/S0140-6736(24)01818-X.
  4. ↑ 4.0 4.1 4.2 4.3 Henry TD, Tomey MI, Tamis-Holland JE; et al. (2021). "Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association". Circulation. 143 (15): e815–e829. doi:10.1161/CIR.0000000000000959.
  5. ↑ Thiele H, Akin I, Sandri M; et al. (2017). "PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock". The New England Journal of Medicine. 377 (25): 2419–2432. doi:10.1056/NEJMoa1710261.
  6. ↑ Thiele H, Akin I, Sandri M; et al. (2018). "One-Year Outcomes after PCI Strategies in Cardiogenic Shock". The New England Journal of Medicine. 379 (18): 1699–1710. doi:10.1056/NEJMoa1808788.
  7. ↑ Damluji AA, van Diepen S, Katz JN; et al. (2021). "Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association". Circulation. 144 (2): e16–e35. doi:10.1161/CIR.0000000000000985.
  8. ↑ 8.0 8.1 8.2 8.3 Cubeddu RJ, Lorusso R, Ronco D; et al. (2024). "Ventricular Septal Rupture After Myocardial Infarction: JACC Focus Seminar 3/5". Journal of the American College of Cardiology. 83 (19): 1886–1901. doi:10.1016/j.jacc.2024.01.041.
  9. ↑ 9.0 9.1 Schlotter F, Huber K, Hassager C; et al. (2024). "Ventricular Septal Defect Complicating Acute Myocardial Infarction: Diagnosis and Management". European Heart Journal. 45 (28): 2478–2492. doi:10.1093/eurheartj/ehae363.
  10. ↑ 10.0 10.1 10.2 Estévez-Loureiro R, Lorusso R, Taramasso M; et al. (2024). "Management of Severe Mitral Regurgitation in Patients With Acute Myocardial Infarction: JACC Focus Seminar 2/5". Journal of the American College of Cardiology. 83 (18): 1799–1817. doi:10.1016/j.jacc.2023.09.840.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Lorusso R, Cubeddu RJ, Matteucci M, Ronco D, Moreno PR (2024). "Ventricular Pseudoaneurysm and Free Wall Rupture After Acute Myocardial Infarction: JACC Focus Seminar 4/5". Journal of the American College of Cardiology. 83 (19): 1902–1916. doi:10.1016/j.jacc.2023.10.054.
  12. ↑ 12.0 12.1 Goubran D, Issa H, Clarizia N, Chan V, Ruel M (2025). "Postmyocardial Infarction Ventricular Septal Rupture: Optimizing Surgical Timing and Repair". Current Opinion in Cardiology. doi:10.1097/HCO.0000000000001256.
  13. ↑ Samsky MD, Morrow DA, Proudfoot AG; et al. (2021). "Cardiogenic Shock After Acute Myocardial Infarction". JAMA. 326 (18): 1840–1850. doi:10.1001/jama.2021.18323.
  14. ↑ Haberman D, Estévez-Loureiro R, Benito-Gonzalez T; et al. (2022). "Conservative, Surgical, and Percutaneous Treatment for Mitral Regurgitation Shortly After Acute Myocardial Infarction". European Heart Journal. 43 (7): 641–650. doi:10.1093/eurheartj/ehab496.
  15. ↑ Matteucci M, Kowalewski M, De Bonis M; et al. (2021). "Surgical Treatment of Post-Infarction Left Ventricular Free-Wall Rupture: A Multicenter Study". The Annals of Thoracic Surgery. 112 (4): 1186–1192. doi:10.1016/j.athoracsur.2020.11.019.
  16. ↑ 16.0 16.1 Heidenreich PA, Bozkurt B, Aguilar D; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure". Journal of the American College of Cardiology. 79 (17): e263–e421. doi:10.1016/j.jacc.2021.12.012.
  17. ↑ Thiele H, Zeymer U, Thelemann N; et al. (2019). "Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction: Long-Term 6-Year Outcome of the Randomized IABP-SHOCK II Trial". Circulation. 139 (3): 395–403. doi:10.1161/CIRCULATIONAHA.118.038201.
  18. ↑ 18.0 18.1 Thiele H, Zeymer U, Akin I; et al. (2023). "Extracorporeal Life Support in Infarct-Related Cardiogenic Shock". The New England Journal of Medicine. 389 (14): 1286–1297. doi:10.1056/NEJMoa2307227.
  19. ↑ 19.0 19.1 19.2 19.3 Møller JE, Engstrøm T, Jensen LO; et al. (2024). "Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock". The New England Journal of Medicine. 390 (15): 1382–1393. doi:10.1056/NEJMoa2312572.
  20. ↑ Morici N, Sacco A, Frea S; et al. (2025). "Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial". Journal of the American College of Cardiology. 85 (16): 1587–1597. doi:10.1016/j.jacc.2025.03.003.
  21. ↑ Møller JE, Beske RP, Engstrøm T; et al. (2025). "Long-Term Outcomes of the DanGer Shock Trial". The New England Journal of Medicine. 393 (10): 1037–1038. doi:10.1056/NEJMc2508284.
  22. ↑ Thiele H, Møller JE, Henriques JPS; et al. (2024). "Temporary Mechanical Circulatory Support in Infarct-Related Cardiogenic Shock: An Individual Patient Data Meta-Analysis of Randomised Trials With 6-Month Follow-Up". Lancet. 404 (10457): 1019–1028. doi:10.1016/S0140-6736(24)01448-X.
  23. ↑ 23.0 23.1 23.2 Sinha SS, Morrow DA, Kapur NK, Kataria R, Roswell RO (2025). "2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Evaluation and Management of Cardiogenic Shock". Journal of the American College of Cardiology. 85 (16): 1618–1641. doi:10.1016/j.jacc.2025.02.018.
  24. ↑ 24.0 24.1 Arai R, Kojima K, Fukamachi D, Okumura Y (2025). "DanGer Shock Criteria and Outcomes in Acute Myocardial Infarction-Related Cardiogenic Shock Treated With Impella: The J-Pvad Registry". European Heart Journal. doi:10.1093/eurheartj/ehaf787.
  25. ↑ 25.0 25.1 Marquard JM, Beske RP, Hassager C; et al. (2025). "Percutaneous Coronary Intervention in Multivessel Disease and Infarct-Related Cardiogenic Shock: A DanGer Shock Substudy". JACC: Cardiovascular Interventions. 18 (18): 2226–2237. doi:10.1016/j.jcin.2025.07.035.
  26. ↑ Zweck E, Beske RP, Hassager C; et al. (2026). "Microaxial Flow Pump Use in Different Phenotypes of Cardiogenic Shock: A Secondary Analysis of the DanGer Shock Trial". Journal of Cardiac Failure. doi:10.1016/j.cardfail.2026.02.015.
  27. ↑ 27.0 27.1 Geller BJ, Sinha SS, Kapur NK; et al. (2022). "Escalating and De-Escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association". Circulation. 146 (6): e50–e68. doi:10.1161/CIR.0000000000001076.
  28. ↑ 28.0 28.1 Schrage B, Becher PM, Bernhardt A; et al. (2020). "Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation". Circulation. 142 (22): 2095–2106. doi:10.1161/CIRCULATIONAHA.120.048792.
  29. ↑ 29.0 29.1 29.2 Tedford RJ, Leacche M, Lorts A; et al. (2023). "Durable Mechanical Circulatory Support: JACC Scientific Statement". Journal of the American College of Cardiology. 82 (14): 1464–1481. doi:10.1016/j.jacc.2023.07.019.
  30. ↑ 30.0 30.1 Blumer V, Kanwar MK, Barnett CF; et al. (2024). "Cardiogenic Shock in Older Adults: A Focus on Age-Associated Risks and Approach to Management: A Scientific Statement From the American Heart Association". Circulation. 149 (14): e1051–e1065. doi:10.1161/CIR.0000000000001214.
  31. ↑ Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 110 (9): e82–e292. PMID 15339869. Unknown parameter |month= ignored (help)
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