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Objectives: Despite increasing use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS) secondary to ST-segment elevation myocardial infarction (STEMI), a paucity of adequate evidence for this therapy remains. The aim of this single-center clinical registry study was to identify predictors of survival and discern the possible optimal time to initiate VA-ECMO in this cohort., Methods and Results: Seventy-nine consecutive patients with CS complicating STEMI who received VA-ECMO support were included in this analysis. The primary endpoint was survival at 6 months after initiation of VA-ECMO. Mean age was 60 ± 11 years. Forty-six patients (58%) were successfully weaned from VA-ECMO and 30 patients (38%) could be discharged. Of these, 23 patients (29% of the overall population) survived up to 6-month follow-up. Multivariate analysis to identify determinants of survival showed no association between the time of CS onset to VA-ECMO start time and 6-month survival (P=.75). Glomerular filtration rate on admission (P<.001), white blood cell count on admission (P≤.01), age (P≤.01), and arterial lactate level 1 and 24 hours after VA-ECMO initiation (P=.01) were the strongest predictors of survival., Conclusions: The timing of VA-ECMO initiation in patients with CS complicating STEMI was not a prognostic factor of survival. Renal function, white blood cell count, age, and lactate level were the strongest predictors of death during 6-month follow-up.