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©2013 UpToDate ® Print Email ACC/AHA/ESC guideline summary: Treatment of cardiogenic shock in patients with acute myocarial infarction (MI)* Class I - There is evidence and/or general agreement that the following approaches are indicated in the treatment of cardiogenic shock in patients with an acute MI: •  Intraaortic balloon counterpulsation when cardiogenic shock is not quickly reversed with pharmacologic therapy. The IABP is a stabilizing measure for angiography and prompt revascularization. •  Intraarterial monitoring. •  Early revascularization with either PCI or CABG for patients less than 75 years of age who develop shock within 36 hours of MI and who are suitable for revascularization that can be performed within 18 hours of shock. This recommendation does not apply when further support is futile because of the patient's wishes or contraindications to or unsuitability for further invasive care. •  Among patients with ST elevation MI, fibrinolytic therapy in those who are not suitable for revascularization and have no contraindications to fibrinolysis. •  Unless assessed by invasive testing, echocardiography to evaluate for possible mechanical complications. Class IIa - The weight of evidence or opinion is in favor of the usefulness of the following approaches in the treatment of cardiogenic shock in patients with an acute MI: •  Pulmonary artery catheterization •  Early revascularization with either PCI or CABG for selected patients 75 years of age or older (eg, patients with good functional status who agree to invasive care) who develop shock within 36 hours of MI and who are suitable for revascularization that can be performed within 18 hours of shock. * These guidelines were for patients with ST elevation MI or MI associated with left bundle branch block. Similar principles apply to cardiogenic shock developing in patients with a non-ST elevation MI. 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 (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004; 110:588.