Impella CP (Abiomed, Danvers, MA, USA) is a percutaneous microaxial flow pump increasingly used in the management of acute myocardial infarction (AMI)-related cardiogenic shock and prophylactically before high-risk percutaneous coronary intervention (HRPCI) [ ]. Although the DanGer Shock trial found a mortality benefit with routine use of Impella CP to treat AMI-related cardiogenic shock, this came at the cost of increased complications, which can mitigate the benefit that Impella CP provides [ ]. Whether the frequency of complications related to Impella is higher in the real world than in clinical trial settings remains a question.