COR indicates class of recommendation; LOE, level of evidence; N/A, not applicable; PCI, percutaneous coronary intervention; and STEMI, ST-elevation myocardial infarction. Levine et al 2011 ACCF/AHA/SCAI PCI Guideline e599 PCI for a hemodynamically significant stenosis in a patent infarct artery 24 hours after STEMI as part of a revascu- larization strategy improves outcome.410,411,413 417 PCI of an occluded infarct artery 1 to 28 days after MI in asymptomatic patients without evidence of myocardial ischemia has no incremental benefit beyond optimal medical therapy with aspirin, beta blockers, angiotensin-converting enzyme inhib- itors, and statins in preserving LV function and preventing subsequent cardiovascular events.418 420 It is important to note that elective PCI of an occluded infarct artery has not been studied in patients with New York Heart Association functional class III or IV heart failure, rest angina, serum creatinine 2.5 mg/dL, left main or 3-vessel CAD, clinical instability, or severe inducible ischemia on stress testing in an infarct zone that is not akinetic or dyskinetic. 5.2.3. Cardiogenic Shock: Recommendations Class I 1. PCI is recommended for patients with acute MI who develop cardiogenic shock and are suitable candi- dates.384,421 423 (Level of Evidence: B) 2. A hemodynamic support device is recommended for patients with cardiogenic shock after STEMI who do not quickly stabilize with pharmacological ther- apy.384,424 427 (Level of Evidence: B) See Online Data Supplement 22 for additional data regarding cardiogenic shock. Cardiogenic shock is the leading cause of in-hospital mortality complicating STEMI. 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. 