The results of the multicentre, open-label IABP-SHOCK II trial showed that intra-aortic balloon pump (IABP) counterpulsation did not reduce 30-day and 1-year mortality in patients with acute myocardial infarction (MI) and cardiogenic shock undergoing early revascularization. A new follow-up report of the study shows that IABP also did not reduce 6-year mortality in these patients. A total of 600 patients with acute MI and cardiogenic shock were randomly allocated to receive or not receive IABP support; analysis of the clinical outcomes of 591 of these patients at long-term follow-up revealed no between-group differences in all-cause mortality and in any other secondary outcome variables such as recurrent MI, stroke or new revascularization procedures. These data support the current guideline recommendations to not use IABP routinely.