Abstract Background/Introduction Cardiogenic shock (CS) after acute myocardial infarction (AMI) carries high mortality despite advances in revascularization and supportive care. Temporary mechanical circulatory support (MCS) is increasingly used as a bridge-to-decision strategy, but the optimal timing for transition to advanced therapies such as heart transplantation (HTx) or durable LVAD remains undefined. Purpose To characterize the short- and mid-term outcomes of AMI-CS patients without absolute contraindications for advanced heart failure therapies, and to identify predictors of recovery, mortality, and transition to definitive therapies. Methods Retrospective analysis of 200 consecutive AMI-CS patients admited to a cardiac intensive care unit, from 2019 to 2025 (confirma sff as datas). Institutional inclusion criteria for advanced HF therapies, including age under 70 years and other common major contraindications for HTx or LVAD were applied. Patients were grouped at day five according to their status: dead, inotrope or MCS dependent (INTERMACS 3 or worse) and recovered from shock. Clinical course and outcomes were assessed at day 30 and during follow up. Preditors of recovery and death after day 5 were obtained through multivariate analysis. Results From a total of 112 included patients, (median age 59 years old (IQR 51-65), 69,6% males) 108 patients underwent emergent coronary angiography and 96, 86% underwent coronary revascularization. Vasopressors were required in 88% and 53% received temporary MCS, most frequently V-A ECMO with intra-aortic balloon pump (n=19, 17%). At day 5, 7 patients (3%) had been discharged, 32 (14%) had recovered but remained hospitalized, 43 (19%) persisted in INTERMACS 3 or worse, and 30 (14%) had died. From the 82 alive patients at day 5, half were discharged at 30 days, while 9 remained hospitalized but clinically recovered from CS, 15 persisted in INTERMACS 3 or worse, 16 had died, and 2 underwent HTx. Independent predictors of mortality at 30 days included cardiac arrest at presentation, higher SCAI stage, longer MCS duration, peak troponin, and biventricular dysfunction (p0.05). Beyond 30 days, another 10 patients received HTx (median time 58 days (IQR 36–87)) and 3 underwent durable LVAD (median 135 days (IQR 76–167)). No patient died while listed for advanced therapies. Conclusions Temporary MCS is frequently used as a bridge to decision, enabling multiorganic failure improvement and hemodynamic stabilization for bridging patients to recovery or advanced HF therapies. While being a highly individualized decision with multidisciplinary input, these data might refine future decision-making processes for AMI-CS patients who do not recover after adequate revascularization, allowing a faster decisionBaseline characteristics. Clinical trajectories.
Jorge et al. (2026) studied this question.