The Intra Aortic Balloon Pump (IABP) is an established support in addition to pharmacologic treatment of the failing heart after myocardial infarction, unstable angina, cardiac surgery and percutaneous coronary intervention (PCI). The indication for IABP in acute myocardial infarction expanded to include support of severely ill patient during acute cardiac catheterization and myocardial revascularization both percutaneous and surgical. An international randomized trial, SHould we emergently revascularized Occluded Coronaries for cardiogenic shocK? (SHOCK) reported that cardiogenic shock patients treated with the combination of IABP support followed by early angiography and myocardial revascularization, and/ or thrombolytic therapy had the lowest observed inhospital mortality. The Benchmark Registry revealed plausible IABP economic benefits in total hospital costs; whereas, the potential benefits of careful use of IABP therapy are unlikely to be offset by vascular and hemorrhagic complications. The inference, whether IABP can be appropriate initial therapy at hospitals without revascularization facilities, if followed by prompt transfer to tertiary centers in the developing world, requires careful assessment.