Evaluation of the Efficacy of Early Implantation of a Percutaneous Left Ventricular Assist Devices in Acute Coronary Syndrome Complicated by Cardiogenic Shock Compared to Conventional Therapy: a Prospective, Multicenter, Randomized, Controlled and Open-label Clinical Trial

Inclusion Criteria: * Age between 18 and 80 years old; * ACS ≤ 24 hours; * Cardiogenic shock defined by: * At least one criteria of low cardiac output defined by * SBP ≤ 90 mmHg or the need to use inotropes/vasopressors in order to obtain SBP\> 90 mmHg * CI ≤ 2.2L/min/m2 * At least one criteria of left overload defined by * clinical (killip class ≥ 2), * biological (NtproBNP \> 900pg/ml or BNP \> 400pg/ml), * radiological * non invasive or invasive hemodynamic evaluation * At least one criteria of malperfusion defined by * clinical (marbles, oliguria ≤ 0.5ml/min/kg, cold/clammy skin and extremities,..) * biological approach (arterial lactate ≥ 2mmol/L, ScVO2 \< 60%) * Stage C or D of the ACC classification of CS * Revascularization by PCI intended after coronary angiography; * Lack of significant femoral artery stenosis or other local contra-indication to a 14 Fr sheath; * Signed informed consent (patient and/or family/relative) or emergency procedure * Subject affiliated to or beneficiary of a social security system. Exclusion Criteria: * Persons referred in articles L.1121-5 to L.1121-8 and L.1122-2 of the Public Health Code: * Pregnant, parturient or breastfeeding woman * Person deprived of liberty for judicial or administrative decision * Adult person under legal protection (any form of public guardianship) * Onset of shock \>24 hours * CS not related to ACS * Patient with prolonged cardiac arrest (\>5 mins) * Contra-indications to Impella CP implantations: * Isolated right ventricular failure * LV thrombus * Mechanical aortic valve or heart constrictive device * Aortic valve stenosis or calcification (equivalent to an orifice area of 0.6cm2 or less) * Moderate to severe aortic insufficiency (echocardiographic assessment graded as ≥ 2) * Severe peripheral arterial disease precluding placement of the Impella system * Combined cardiorespiratory failure * Presence of an Atrial or Ventricular Septal Defect (including post infarctus VSD) * Left ventricular rupture Cardiac tamponade * Mechanical complication of myocardial infarction * Cerebral deficit with fixed dilated pupils or irreversible neurological pathology * Anoxic brain injury * Active bleeding * Contra-indication to antiplatelet or anticoagulant therapy * Life expectancy \< 1 year