Cardiogenic Shock: Contemporary Management, Risk Stratification and Phenotyping

Background. Cardiogenic shock (CS) is a highly lethal clinical syndrome characterised by inadequate cardiac output and end-organ hypoperfusion. Despite advances in contemporary management, mortality remains unacceptably high. The aetiological spectrum of CS is broadening beyond acute myocardial infarction, and management continues to be challenged by limited and often conflicting evidence. Aim. To review the current evidence regarding the diagnosis, classification, risk stratification and management of cardiogenic shock, with particular emphasis on clinical phenotyping and the role of mechanical circulatory support. Material and methods. A narrative literature review was conducted using published studies, randomised trials, observational data, and contemporary international guidelines addressing the diagnosis and management of cardiogenic shock. Results. Early identification, treatment of the underlying cause and haemodynamic stabilisation with vasoactive agents remain the cornerstones of CS management. While early revascularisation in acute myocardial infarction-related cardiogenic shock has demonstrated mortality benefits, evidence supporting the use of mechanical circulatory support remains largely inconclusive, and the optimal timing, modality and patient selection are uncertain. The heterogeneity of the CS population, together with the lack of universally accepted diagnostic criteria and classification systems, complicates trial design and interpretation and has stimulated interest in phenotype-based approaches. Conclusions. Cardiogenic shock remains a complex and heterogeneous syndrome associated with high mortality. Improved diagnostic frameworks, refined risk stratification and phenotype-guided management strategies may facilitate more individualised treatment and improve future research and clinical outcomes.