The following are key points to remember from this 2019 update on management of cardiogenic shock (CS) complicating myocardial infarction (MI):

1. CS remains the most common cause of death in patients admitted with acute MI, and mortality remained relatively unchanged in the range of 40-50% during the last two decades.
2. CS is defined as a state of critical end-organ hypoperfusion and hypoxia due to primary cardiac disorders, and the diagnosis can be made on the basis of clinical criteria such as persistent hypotension without adequate response to volume replacement and accompanied clinical features of end-organ hypoperfusion such as cold extremities, oliguria, or altered mental status.
3. Mechanistically in CS, there is a profound depression of myocardial contractility resulting in a potentially deleterious downward spiral of reduced cardiac index, low blood pressure, and further coronary ischemia, followed by additional reductions in contractility.
4. Early revascularization, vasopressors and inotropes, fluids, mechanical circulatory support (MCS), and general intensive care measures are widely used for CS management. However, there is only limited evidence for any of the above treatment strategies except for revascularization and the relative ineffectiveness of intra-aortic balloon pumping.
5. In general, patients with CS should best be treated at specialized tertiary CS care centers.
6. Based on the SHOCK trial, early revascularization is the most important treatment strategy in CS after MI. Revascularization should be limited to the culprit lesion with possible staged revascularization of other lesions at a later time point based on contemporary evidence.
7. Based on a meta-analysis suggesting lower mortality with norepinephrine over epinephrine or dopamine, norepinephrine is the vasoconstrictor of choice when blood pressure is low and tissue perfusion pressure is insufficient.
8. Despite an increasing number of different percutaneous MCS devices for either left or right ventricular support, data derived from randomized clinical trials on the effectiveness, safety, differential indications for different devices, and optimal timing are still limited.
9. Current guidelines recommend considering the use of percutaneous MCS in selected patients depending on patient age, comorbidities, and neurological function, in particular, in refractory CS without any preference for device selection.
10. Several ongoing randomized trials in the setting of CS may lead to an improvement in understanding optimal treatment strategies and better short- and long-term outcomes.

Keywords: Acute Coronary Syndrome, Blood Pressure, Coronary Artery Disease, Critical Care, Dopamine, Epinephrine, Heart Failure, Hypotension, Intra-Aortic Balloon Pumping, Myocardial Infarction, Myocardial Revascularization, Norepinephrine, Oliguria, Secondary Prevention, Shock, Cardiogenic, Vasoconstrictor Agents

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