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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Intraaortic balloon pump (IABP) in acute myocardial infarction (MI) Class I - There is evidence and/or general agreement that an IABP should be used in patients with acute MI in the following settings •  Hypotension (systolic pressure less than 90 mm Hg or ≥30 mmHg below the baseline mean arterial pressure) that does not respond to other interventions unless further support is limited by patient's wishes or contraindications or unsuitability for further invasive care. •  Low-output state •  Cardiogenic shock not quickly reversed with pharmacologic therapy as a stabilizing measure for angiography and prompt revascularization. •  Recurrent ischemic-type chest discomfort and hemodynamic instability, poor left ventricular function, or a large area of myocardium at risk. Such patients should be referred for urgent cardiac catheterization and, if appropriate, revascularization. Class IIa - The weight of evidence or opinion is in favor of benefit from an IABP in patients with acute MI in the following setting •  Refractory polymorphic ventricular tachycardia in an attempt to diminish myocardial ischemia. Class IIb - The evidence or opinion is less well established for an IABP in patients with acute MI in the following setting •  Refractory pulmonary congestion. Data from Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2004; 110:588.