Acute myocardial infarction and cardiogenic shock (AMI-CS) remains a disease state associated with high morbidity and mortality. There have been three distinct eras within modern medicine defining AMI-CS care. The first era compromised treatment with vasoactive agents, use of intra-aortic balloon pumps and thrombolytic therapy and was associated with a mortality of 80 %. The second era included the advent of revascularization, particularly percutaneous coronary interventions, which improved AMI-CS mortality to 50 % [ 1 ]. The third and present era includes the use of shock protocols and teams which more frequently utilize early mechanical circulatory support (MCS) devices guided by invasive hemodynamics [ 2 , 3 ]. While there is hope that mortality will be further enhanced, data available to date remain highly selected.