How have the findings from DanGer Shock RCT changed your perspective on which patients presenting with acute MI complicated by cardiogenic shock would benefit from Impella for additional hemodynamic support?

First and foremost, it is notable that DanGer Shock (Møller et al., PMID 38587239) was the first randomized trial to show a mortality benefit with the use of a microaxial flow pump in acute MI-associated cardiogenic shock - a practice that proliferated based upon promising outcomes in non-randomized...

I think the microaxial pump has already changed shock management; that being said, additional improvement in outcome can be obtained by patient selection only, everything else being equal. Next will be fewer complications as Frenching will decline.

The answer is no.

I have studied the DanGer Shock trial in detail and I am not satisfied with its design and outcomes. They should have compared the Impella to IABP. Also, patients in the non-impella arm were sicker (Significantly higher severe shock), yet they did not even get IABP support. We need...