The left circumflex coronary artery was the culprit vessel in 30% of patients with NSTEMI, suggesting the presence of true poste- Dopamine in patients with cardiogenic shock may be associated with increased mortality compared with norepi- The use of percutaneous ventricular assist devices has been hampered by the need for interventional expertise, cost, and lack of supportive evidence.597 IABP has been used for and it may facilitate intervention in patients who are hemodynamically unstable, but it did not reduce mortality or secondary endpoints in 1 RCT of 598 patients with cardiogenic shock complicating AMI.268 Newer devices with higher levels of support have provided better hemodynamic support but without improved clinical outcomes compared with IABP.599,600 See Online Data Supplement 26 for additional information on cardiogenic shock. 7.3. Diabetes Mellitus: Recommendation Class I 1. Medical treatment in the acute phase of NSTE-ACS and decisions to perform stress testing, angiography, and re- vascularization should be similar in patients with and without diabetes mellitus.138,339,601 (Level of Evidence: A) CAD accounts for 75% of deaths in patients with diabetes mel- litus; >30% of patients with NSTE-ACS have diabetes mellitus; and patients with NSTE-ACS and diabetes mellitus have more adverse outcomes (eg, death, MI, readmission withACS, or HF) during follow up.593,602,603 The latter may be related to increased plaque instability and comorbidities, including hypertension, LV hypertrophy, cardiomyopathy, HF, and autonomic dysfunc- Patients with diabetes mellitus and ACS have longer delays from symptom onset to presentation,593,606,607 which may be attributable to their atypical symptoms. There is a U-shaped relationship between glucose levels and mortality in patients with diabetes mellitus and ACS.543 Both hyperglycemia and hypoglycemia have similar adverse effects on in-hospital and 6-month mortality. 