A 52-year-old man with acute myocardial infarction and cardiogenic shock (SBP 85 mmHg, HR 105/min, CI 1.8 L/min/m², PCWP 22 mmHg) is on dobutamine 5 mcg/kg/min. Despite this, cardiac index remains low and systemic hypotension worsens. What is the most appropriate next step?

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