Cardiogenic Shock: A State-of-the-Art Review

Cardiogenic shock is a state of inadequate tissue perfusion caused by severe cardiac dysfunction, representing a critical emergency in cardiovascular medicine. Over the past two decades, its profile has evolved from being primarily ischemic to increasingly driven by heart failure and other nonischemic etiologies. Modern classification systems, including the Society for Cardiovascular Angiography and Interventions stages and the Shock Academic Research Consortium framework, have standardized diagnosis and improved risk stratification across etiologies. Traditional management relied on pharmacotherapy and early revascularization to restore perfusion, while newer strategies incorporate mechanical circulatory support devices, alongside multidisciplinary shock teams, CICU liberation bundles, and structured family engagement. These therapeutic and system-level advances have contributed to steady declines in in-hospital mortality and improved early outcomes. In conclusion, as survival continues to improve, the focus of cardiogenic shock care is shifting toward survivorship, addressing long-term physical, cognitive, and psychological recovery to ensure that survival translates into meaningful, independent living.