Revascularization is the only treatment proven to decrease mortality rates.384,421 423 Al- though revascularization is almost always accomplished through PCI, selected patients with severe 3-vessel or left main disease can benefit from emergency CABG. Revascu- larization attempts may be futile and not indicated in cases of severe multiorgan failure.427 Patient selection for revascular- ization is more important in the elderly, but several observa- tional reports demonstrate acceptable outcomes in patients with few comorbidities and a reasonable potential for sur- vival.428 431 Patients who present to hospitals without PCI capability are usually emergently transported to a PCI center, because mortality without transfer is markedly elevated.432 5.2.3.1. Procedural Considerations for Cardiogenic Shock Patients with cardiogenic shock should receive standard pharmacological therapies, including aspirin, a P2Y12 recep- tor antagonist, and anticoagulation.427,433 Inotropic and vaso- pressor therapy improves perfusion pressure. Historically, negative inotropes and vasodilators are avoided. IV GP IIb/IIIa inhibitors have been shown to provide benefit in observational studies but not in 1 small RCT.433 Endotracheal intubation and mechanical ventilation with positive end-expiratory pressure is usually necessary in pa- tients with respiratory failure. Placement of a temporary pacemaker is indicated for patients with bradycardia or high-degree atrioventricular heart block. A pulmonary artery catheter can provide information to dose and titrate inotropes and pressors. Further hemodynamic support is available with IABP counterpulsation or percutaneous LV assist devices, although no data support a reduction in mortality rates.434 Contrast medium injections should be minimized. Orthog- onal angiograms of the left coronary artery and a left anterior oblique angiogram of the right coronary artery are usually sufficient to identify the infarct artery.435 Although most patients undergoing revascularization will receive a stent as part of the procedure, there are conflicting data on the impact of stenting over balloon angioplasty. 