In patients undergoing percutaneous coronary intervention for acute myocardial infarction (AMI) complicated by cardiogenic shock, use of an intravascular microaxial left ventricular assist device (LVAD) is associated with worse clinical outcomes than use of an intra-aortic balloon pump (IABP). This finding comes from a propensity-matched, registry-based, retrospective cohort study that assessed 28,304 patients, 6.2% of whom received haemodynamic support with an LVAD and 29.9% with an IABP. In the propensity-matched cohort (n = 3,360), LVAD use was associated with a greater risk of in-hospital death (45.0% versus 34.1%) and major bleeding (31.3% versus 16.0%) than IABP use. Importantly, these associations were consistent regardless of the timing of device placement. Additional research is required to understand the optimal device choice for these patients.