Role of Cardiogenic Shock Centres and Regionalised Networks for Acute MI-related Cardiogenic Shock: State-of-the-art Review on Behalf of the British Cardiovascular Interventional Society Focus Group

Cardiogenic shock (CS) complicating acute MI (AMI-CS) remains associated with high mortality and morbidity, despite advances in coronary revascularisation and mechanical circulatory support (MCS). Outcomes are determined not only by individual therapies, but also by the organisation of care, with current guidelines emphasising multidisciplinary, system-level approaches to enable rapid diagnosis, triage and treatment. This review examines how CS centres function within regional networks of care. We review definitions of AMI-CS, including haemodynamic, clinical and biochemical markers and their application to early identification and triage. We summarise key components of centre-based management, including revascularisation, invasive haemodynamic assessment, selective MCS use and post-percutaneous coronary intervention critical care. Contemporary data from dedicated CS centres and regionalised network models are compared, highlighting variations in transfer criteria and hub–spoke organisation alongside limitations in current evidence. The distinct phenotypic nuances of out-of-hospital cardiac arrest-associated CS are discussed and gaps in evidence with future perspectives are highlighted.