Despite advances over the past decade, the incidence of cardiogenic 
shock secondary to acute myocardial infarction has increased, with an 
unchanged mortality near 50%. Recent trials have not clarified the best 
strategies in treatment. While dedicated cardiac shock centers are being
 established, there are no standardized agreements on the utilization 
of mechanical circulatory support and the timeliness of percutaneous 
coronary intervention strategies. In some centers and prospective 
registries, outcomes after placement of advanced mechanical circulatory 
support prior to reperfusion therapy with percutaneous coronary 
intervention have been encouraging with improved survival. Here, we 
suggest systems of care with a treatment pathway for patients with acute
 myocardial infarction complicated by cardiogenic shock.