Circulatory Disturbances in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: Mechanisms, Management, and Outcomes

Circulatory disturbances in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) present significant challenges in interventional cardiology. This review examines the pathophysiological mechanisms, management strategies, and outcomes associated with these hemodynamic complications, ranging from transient hypotension to severe cardiogenic shock (CS). The complex interplay between myocardial ischemia, reperfusion injury, and procedural stress creates a dynamic circulatory environment that requires careful monitoring and intervention. The review analyzes various causes of circulatory disturbances, including vasovagal reflexes, allergic reactions, cardiac arrhythmias, acute ischemia, and procedural complications. It emphasizes the importance of early recognition and appropriate management of these conditions to improve patient outcomes. The progression from hypotension to CS is examined, with a focus on assessment tools, prognostication, and revascularization strategies. The role of mechanical circulatory support devices in managing severe circulatory compromise is discussed, including intra-aortic balloon pumps, Impella devices, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Recent randomized controlled trials have yielded mixed results regarding the efficacy of these devices, highlighting the need for a nuanced, patient-centered approach to their use. This comprehensive analysis provides clinicians with a framework for anticipating, identifying, and managing circulatory disturbances in ACS patients undergoing PCI. It underscores the importance of risk stratification, multidisciplinary approaches, and ongoing research to optimize patient care and improve outcomes in this high-risk population.