The current use of vasoactive agents in cardiogenic shock related to myocardial infarction and acute decompensated heart failure

Cardiogenic shock (CS) is a heterogeneous condition associated with exceptionally high mortality rates, despite significant advances in the field of cardiology. The primary causes of CS are myocardial infarction-related CS (AMI-CS) and acute decompensated heart failure-related CS (ADHF-CS). Management of CS is inherently complex, with the initial focus—irrespective of the underlying etiology—centered on preserving end-organ perfusion. Parenteral vasopressors and inotropes are the cornerstone of therapy to achieve this objective. However, data on the comparative efficacy of different vasoactive agents in CS remain limited, and no single agent has demonstrated clear superiority. Recent progress in the staging and phenotyping of CS has provided a framework for more tailored therapeutic approaches. This review offers a comprehensive and updated summary of current evidence on the use of vasopressors and inotropes in AMI-CS and ADHF-CS, including a discussion of specific scenarios, such as right ventricular CS (RV-CS).