Background: Acute myocardial infarction-related cardiogenic shock (AMI-CS) remains associated with high mortality despite advances in revascularization, critical care, and temporary mechanical circulatory support (MCS). Recent randomized trials have challenged the concept of routine device-based therapy and highlighted the importance of matching MCS strategy to shock phenotype, timing, and patient risk profile. Methods: We reviewed contemporary randomized clinical trials and prespecified or post hoc analyses evaluating temporary MCS strategies in adult patients with AMI-CS. PubMed was searched for English-language studies published from January 2021 through June 2026, focusing on intra-aortic balloon pump (IABP), microaxial flow pumps, and venoarterial extracorporeal membrane oxygenation (VA-ECMO/ECLS). Outcomes of interest included mortality, hemodynamic recovery, end-organ outcomes, and device-related complications. Results: Recent randomized evidence demonstrates that no temporary MCS device provides universal benefit across the heterogeneous AMI-CS population. Routine IABP use has not been associated with improved survival and is now reserved for selected patients requiring modest circulatory support, bridge-to-decision strategies, or specific mechanical complications. The DanGer Shock trial provided the strongest contemporary randomized evidence supporting temporary MCS, demonstrating reduced 180-day mortality with routine Impella CP support in carefully selected patients with STEMI-related cardiogenic shock. However, this benefit was accompanied by increased major bleeding, limb ischemia, acute kidney injury, and renal replacement therapy. Prespecified secondary and exploratory post hoc analyses have generated hypotheses that treatment response may vary according to age, baseline hemodynamics, timing of support, and shock phenotype; however, these findings require prospective validation and should not be interpreted as established treatment-selection criteria. In contrast, ECLS-SHOCK, ECMO-CS, EURO SHOCK, and randomized meta-analytic data did not demonstrate a survival benefit for routine early VA-ECMO in broad AMI-CS populations and consistently identified higher rates of bleeding and vascular complications. Strategies for routine early left ventricular unloading during VA-ECMO have improved physiologic parameters but have not demonstrated a mortality benefit. Conclusions: Contemporary randomized trials have shifted the role of temporary MCS in AMI-CS from routine device deployment toward individualized, phenotype-guided therapy. Impella CP, as evaluated in the DanGer Shock trial, currently provides the strongest randomized survival signal but should be applied selectively in patients with predominantly left ventricular failure treated within experienced shock systems. VA-ECMO remains an important rescue option in carefully selected patients with refractory circulatory collapse, severe hypoxemia, cardiac arrest, or biventricular failure, although routine early use is not supported. Future research should focus on earlier shock phenotyping, physiology-guided device selection, complication reduction, and strategies that integrate mechanical support with recovery-focused care.

Background: Sudden cardiac death (SCD) and sudden cardiac arrest (SCA) remain leading causes of mortality in young athletes, highlighting the importance of cardiac screening prior to play. The guidelines on screening protocol are continually evolving but are often inconsistent across organizations. We explore the role of different screening modalities including electrocardiography (ECG) and various cardiac imaging testing; their effectiveness, cost considerations and clinical utility regarding sports cardiac screening, comparing European and American cardiac screening protocols. Additionally, we also discuss the divergence between the European and American guidelines and appraise the literature surrounding this topic. Methods: A comprehensive literature review was conducted using studies published between 2010–2025 on cardiac screening for young athletes. Parameters included an English filter with review of observational studies, systematic reviews, meta-analyses, and randomized controlled trials (RCTs). Manual searches of PubMed, Embase, and Google Scholar libraries were also performed to enhance the reach of our investigation. Articles were chosen based on relevance to the topic. Results: When compared to PPCS physical exam, ECG advantages include increased detection of cardiac conditions leading to SCD, improved sensitivity and specificity compared to history alone, Disadvantages are the need for trained specialists to complete testing properly, unreliability for detecting congenital coronary anomalies, cost-effectiveness concerns, and false positive risk. However, these disadvantages can be improved with improved ECG interpretation training for non-cardiologists and policies easing access to advanced cardiac care. Conclusions: ECG remains the cornerstone of cardiovascular screening due to its affordability and sensitivity in detecting electrical abnormalities, its limitations necessitate a multimodal approach. Integrating targeted ECG screening with echocardiography and advanced imaging in select cases may enhance diagnostic accuracy while balancing cost-effectiveness and accessibility. While the benefits of routine ECG are strongly supported by the literature, nationwide implementation of it remains challenging due to economic, geographical and logistical restraints. Therefore, more research needs to be conducted on the mortality benefits and cost-effectiveness of routine ECGs implementation in PPCS screening for young athletes.