Cardiogenic shock is a heterogeneous disease that remains a major unsolved problem despite advances in definitions, staging, and phenotyping. Mortality is 41% in patients with infarct-induced cardiogenic shock, 31% in those with new heart failure or secondary causes, and 25% in acutely aggravated chronic heart failure. Causes of death are often difficult to determine due to multi-organ failure or withdrawal of life support. Early use of pulmonary artery catheters is recommended in selected patients unresponsive to initial therapy or in diagnostic or therapeutic uncertainty, such as in mixed shock. The understanding of the etiological factors of cardiogenic shock has changed. Studies examining changes in IL-6 levels at 3 days, mortality at 30 days, and use of VA-ECMO, some were stopped for safety or included Bayesian analysis. Lactate >5 mmol/L or mitral regurgitation 3+ or 4+ are used for inclusion in the studies. The article is a review from NEJM 2026;394:62-77.[2]