Indications for permanent pacing are reviewed in the 2012 device-based therapy CPG.20 7.2.2. Cardiogenic Shock: Recommendation Class I 1. Early revascularization is recommended in suitable patients with cardiogenic shock due to cardiac pump failure after NSTE-ACS.560,588,589 (Level of Evidence: B) AMI is the leading cause of cardiogenic shock. Early revascular- ization is a mainstay in the treatment of cardiogenic shock.560,589 Compared with medical therapy, early revascularization is asso- ciated with improved 6-month mortality560 and 13% absolute mortality reduction at 6 years.588 Urgent revascularization with CABG may be indicated for failed PCI, coronary anatomy not amenable to PCI, and at the time of surgical repair of a mechani- cal defect (eg, septal, papillary muscle, free-wall rupture). Age alone is not a contraindication to urgent revascularization for Mortality after cardiogenic shock has including in older adults,589,590 mortality ranging from approximately 40% with milder forms of to >45% with refractory shock.592 of patients in the IABP-SHOCK (Intra-Aortic Balloon Pump in Cardiogenic Shock) II trial presented with NSTEMI,268 of patients in the TRIUMPH (Tilarginine Acetate Injection in a Randomized International Study in Unstable Acute Myocardial Infarction PatientsWith Cardiogenic Shock) trial had ST depres- sion on presentation.592 Of the 23% of patients with ACS who had NSTEMI in the GRACE registry, 4.6% of patients experi- enced cardiogenic shock.593 Of the 2992 patients in shock, 57% underwent cardiac catheterization, and in-hospital revasculariza- tion was performed in 47% of this group. 