In experimental studies, IABP counterpulsation increases diastolic BP and coronary blood flow and potentially augments cardiac output while diminishing LV end-diastolic pressure. The use of IABP for refractory ischemia dates back several decades, and its current application is predominantly driven by clinical experi- ence and nonrandomized observational studies.265 When stud- ied in rigorous RCTs, IABP counterpulsation failed to reduce MACE in high-risk elective PCI,266 decrease infarct size after primary PCI for acute STEMI,267 or diminish early mortality in patients with cardiogenic shock complicating AMI.268 4.1.2.6. Cholesterol Management Class I 1. High-intensity statin therapy should be initiated or continued in all patients with NSTE-ACS and no con- traindications to its use.269 273 (Level of Evidence: A) Class IIa 1. It is reasonable to obtain a fasting lipid profile in pa- tients with NSTE-ACS, preferably within 24 hours of presentation. (Level of Evidence: C) Therapy with statins in patients with NSTE-ACS reduces the rate of recurrent MI, coronary heart disease mortality, need for myocardial revascularization, and stroke. High-risk patients, such as those with NSTE-ACS, derive more benefit in reducing these events from high-intensity statins, such as atorvastatin which lower low-density lipoprotein cholesterol levels by 50% as in the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction) and MIRACL (Myocardial Ischemia Reduction With Acute Cholesterol Lowering) trials,273,274 than from moderate- or low-intensity statins.18,272 These findings provide the basis for high-intensity statin therapy after stabi- lization of patients with NSTE-ACS. In addition, early intro- duction of this approach can promote improved compliance with this regimen. 4.2. Inhibitors of the Renin-Angiotensin- Aldosterone System: Recommendations Class I 1. 