Pioneering progress in cardiogenic shock: a bold leap into the future of acute cardiovascular care

Cardiogenic shock (CS) remains one of the most critical and life-threatening conditions in acute cardiovascular care and presents clinicians with a formidable challenge.1–4 This complex syndrome, triggered by decompensation of chronic heart failure, acute myocardial infarction (AMI), or other cardiovascular insults, demands urgent and tailored interventions to enhance survival.5–9 Despite substantial advances in technology and pharmacotherapy, outcomes for these patients remain poor, particularly among those with complicating comorbidities such as cancer, liver dysfunction, and chronic respiratory diseases.10–12 As highlighted by recent landmark trials, there is still much to be done to ensure better survival rates for this high-risk population. The ECLS-SHOCK trial found no significant benefit of early extracorporeal life support (ECLS) in reducing 30-day mortality in patients with AMI complicated by CS (AMICS), despite more complications like bleeding,13–15 which carries with it a strikingly adverse prognosis.16 In contrast, the DanGer-SHOCK trial demonstrated that adding the Impella CP microaxial flow pump to standard care reduced 180-day mortality in AMI-related CS, though it also increased complications.17–19 In this issue of European Heart Journal—Acute Cardiovascular Care, we explore the evolving landscape of CS management, featuring groundbreaking studies and critical insights. Dr Shashank S. Sinha’s20 editorial offers a comprehensive perspective on the current state of CS management, underscoring the need for individualized care in this complex syndrome. As you read on, you will encounter a series of studies that push the boundaries of what we know about CS and how we treat it. An eye-opening study by Dr Lui et al.21 highlights the increased risks faced by cancer patients admitted for heart failure-related CS. Analysing data from 137 316 admissions between 2014 and 2020, the research reveals critical differences in outcomes between cancer patients (n = 7306) and non-cancer patients. Cancer patients are at a significantly higher risk for in-hospital death, thrombotic complications, and major bleeding, with varying risks based on cancer type. In the CZECH-SHOCK registry, Michal Pazdernik et al.22 present a landmark national, prospective analysis of CS across 15 tertiary care centres in Czechia. Among 418 patients, the study reports a high 30-day mortality rate of 39.5%, despite mechanical circulatory support (MCS) use in 28.2% of cases. These findings underscore the urgent need for individualized treatment strategies and refined risk stratification in this critically ill population, providing crucial real-world data to guide future clinical trials and inform healthcare policy. Aligning with this effort to improve CS management, Elma J. Peters et al.23 introduce a robust 30-day mortality prediction model for AMICS, developed from over 2200 patients in the Netherlands and externally validated in Denmark. The model outperforms existing tools, offering clinicians a validated, rapid, and practical method for accurate risk assessment—essential for improving outcomes in AMICS. This rigorously developed and externally validated model is not only a leap forward in clinical decision-making but also an asset for quality assessment and patient selection in future trials. Shifting focus to an often-overlooked factor in heart care, Zakaria Alaoui-Ismaili et al.24 bring a fresh perspective on the role of liver injury in CS outcomes. In their retrospective cohort study of 1716 AMICS patients, they examined how liver dysfunction—measured using the MELD-albumin score—is associated with mortality rates. Their findings are sobering that patients with higher MELD-albumin scores faced much higher mortality rates, with 49% dying within 30 days and 58% within 10 years, compared to those with healthier liver function. Even after accounting for other serious conditions like right ventricular failure and kidney injury, liver dysfunction remained a strong predictor of poor outcomes. This study underscores the importance of the cardio-hepatic connection and suggests that adding liver injury markers to current risk models could improve patient assessment and lead to more tailored interventions. It is a reminder that when treating complex heart conditions, we cannot overlook the vital role other organs play. In another compelling sub-analysis of the ECLS-SHOCK trial, Mohammad Abumayyaleh et al.25 explore a crucial question in the management of infarct-related CS: does access site during PCI impact patient survival—especially in the context of extracorporeal life support (ECLS)? Among 415 patients with infarct-related CS, 30-day mortality was significantly higher in the femoral access group (52.0%) compared with the radial group (37.8%), with a relative risk of 1.37 (P = 0.011). This pattern persisted across both ECLS and conservative arms. Despite comparable safety outcomes, femoral access showed a strong trend toward being associated with higher mortality in multivariate analysis. Importantly, nearly one in five patients intended for radial access required conversion to femoral, underlining the challenges of maintaining radial strategy in advanced CS. While bleeding risks were similar between groups, the mortality advantage of radial access—even in this critically ill population—calls for renewed focus on operator expertise and procedural planning. Do not miss this essential read redefining risk prediction in one of cardiology’s most high-stakes scenarios. In this issue of European Heart Journal—Acute Cardiovascular Care, Dr Abraham Cherukara26 unveils a game-changing vision for acute cardiac care with the Home Hospital (HH) model. Delivering hospital-level treatment in the comfort of patients’ homes, HH promises shorter stays, lower costs, and higher satisfaction. This must-read article lays out a powerful roadmap for managing heart failure, atrial arrhythmias, and venous thromboembolism at home—while tackling the urgent need for standardized protocols. The June 2025 issue of European Heart Journal—Acute Cardiovascular Care provides invaluable insights into the diverse causes, emerging therapies, and prognostic markers of CS. The research presented herein underscores the complexity of this high-stakes condition and highlights the importance of personalized, evidence-based treatment approaches. As we continue to push the boundaries of CS management, these groundbreaking studies offer hope and direction for the future, driving us closer to the day when we can significantly improve survival and quality of life for patients suffering from this devastating condition. We invite you to explore the inspiring findings of this issue and join us in the quest for better outcomes for CS patients. Together, let us continue advancing the science of acute cardiovascular care to reshape the future of this critical discipline. Pascal Vranckx (Writing—original draft [lead]), David A. Morrow (Writing—review & editing [equal]), Sean van Diepen (Writing—review & editing [equal]), and Frederik H. Verbrugge (Writing—review & editing [equal]) No external funding. No new data were generated or analysed in support of this research.

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