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n engl j med 394;1 nejm.org January 1, 202662T h e n e w e ng l a n d j o u r na l o f m e dic i n e Review Article Author affiliations are listed at the end of the article. Holger Thiele can be contact- ed at holger.thiele@medizin.uni-leipzig.de or at Heart Center Leipzig at Leipzig Uni- versity, Department of Internal Medicine– Cardiology, Strümpellstr. 39, 04289 Leipzig, Germany. N Engl J Med 2026;394:62-77. DOI: 10.1056/NEJMra2312086 Copyright © 2026 Massachusetts Medical Society. Sum m a r y Cardiogenic shock remains a major unsolved problem despite progress such as implementation of new definitions, staging categories, and detailed phenotyping of this heterogeneous disorder. However, there are few evidence-based strategies to decrease mortality, which remains at 40 to 50% at 30 days after the onset of cardiogenic shock; such strategies currently include revascularization of the culprit lesion in myocardial infarction-related cardiogenic shock and the use of micro- axial flow pumps in selected patients with ST-segment elevation myocardial in- farction. Here, we summarize recent advances in the management and diagnosis of cardiogenic shock, including staging and therapies, and ...