Patients with acute myocardial infarction are at risk of developing cardiogenic shock with high mortality. Early revascularization and intensive care therapy constitute the therapy foundation in this setting. Intra-aortic ballon counterpulsation (IABP) represents the most commonly used mechanical assist system, backed by a class IB-recommendation in the AHA/ACC guidelines. Evidence is mostly based on registry data or expert consensus. The study´s goal was to assess the influence on hemodynamics and changes in severity of disease during IABP therapy. Fourty patients were randomly assigned to a therapy either with or without IABP in the prospective, monocentric IABP shock trial and APACHE II score, cardiac index, serum-BNP and serum-IL-6 were monitored initially as well as serially. IABP use did not result in significant changes of the APACHE II score, the cardiac index nor serum-IL6. Thus, no effect on the development of morbidity and inflammation can be assumed. However, significant serum-BNP reduction supports the concept of ventricular unloading during IABP therapy.