Acute Myocardial Infarction versus Acute Decompensated Heart Failure in Cardiogenic Shock: A Systematic Review and Meta-Analysis of Clinical Phenotypes and Mortality

BACKGROUND/AIM: Cardiogenic shock (CS) encompasses distinct phenotypes driven by acute myocardial infarction (AMI-CS) and acutely decompensated heart failure (ADHF-CS). Consolidated comparative evidence remains limited. This meta-analysis compared presentation, management, and short-term mortality between AMI-CS and ADHF-CS. METHODS: Observational studies between 2019 and 2025 comparing AMI-CS and ADHF-CS were summarised in accordance with PRISMA 2020. Random-effects models (REML with Hartung-Knapp) were used to estimate odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals. The primary outcome was short-term (in-hospital/30-day) mortality. RESULTS: Twenty-nine studies (497,368 patients) were pooled. AMI-CS patients were older (MD 4.76 years, 95% CI 0.37-9.14) with higher ejection fraction at presentation (MD 6.04%, 4.53-7.55). AMI-CS presented more fulminantly, with greater odds of cardiac arrest (OR 2.03, 1.04-3.98) and SCAI stage D/E shock (OR 1.50, 1.33-1.70); invasive filling pressures did not differ. Phenotype-defining variables (LVEF, SCAI stage, invasive haemodynamics) were extractable in <1.1% of the pooled cohort. Temporary mechanical circulatory support was more frequent in AMI-CS (any device OR 5.44, 2.83-10.46; IABP OR 4.73; pVAD OR 2.67; VA-ECMO OR 3.27). Destination therapy was much less frequent (OR 0.09, 0.03-0.24); major bleeding was modestly higher (OR 1.36, 1.02-1.82). Short-term mortality was higher in AMI-CS (OR 1.58, 1.06-2.37). CONCLUSION: AMI-CS presents more fulminantly than ADHF-CS, with markedly greater mechanical support use and higher short-term mortality. A dual-axis framework integrating shock severity with aetiology is proposed as an organising principle for hypothesis generation; validation in prospective, phenotype-rich cohorts is required.