Upstream Detection of Cardiogenic Shock: Redefining the Window of Opportunity

Cardiogenic shock (CS) remains associated with high mortality despite progress in drug and mechanical treatments. Current interventions often come too late in the course of the disease, with significant variability in management, reducing their potential effectiveness. Early recognition of CS, along with timely intervention, is a central tenet underlying the Society for Cardiovascular Angiography and Intervention (SCAI) staging system. SCAI Stage B shock provides an important opportunity for upstream detection but remains under-recognized. Additionally, relying on hypotension, lactate, and overt end-organ failure as markers delays CS recognition. By shifting the focus upstream, we have the potential to move from salvage to prevention, offering patients not only longer survival but also better recovery. This review outlines limitations in current CS management, suggests frameworks for early detection, and examines the potential and challenges of new monitoring and treatment options. Investing in perfusion monitoring technology, artificial intelligence-driven risk assessment, and multidisciplinary response teams offer the best strategy to lower CS-related deaths.