European criteria for diagnosing cardiogenic shock
One new position statement — ACVC/HFA/EAPCI propose a three-pillar definition that mandates resting hypoperfusion.
A quiet day after the ESC Congress opening. One new position statement, and it is directly relevant.
Checked with nothing new: SFAR, SRLF, SPILF, ESAIC, ESICM, ESPEN, SCCM, EACTS, STS, IACTS. A Europe PMC sweep of Clinical Infectious Diseases, European Heart Journal, Anaesthesia, AJRCCM, Intensive Care Medicine and Circulation for guideline, consensus, recommendation, position or criteria titles dated 27–31 August returned nothing beyond what is already in the archive. ESC Congress closes tomorrow; the Fifth Universal Definition of Myocardial Infarction was formally presented today and is in the 28 August entry.
Criteria for the diagnosis of cardiogenic shock — a European perspective
Society · Published: Association for Acute CardioVascular Care, Heart Failure Association and the European Association of Percutaneous Cardiovascular Interventions, of the ESC. European Heart Journal: Acute Cardiovascular Care 2026;15(8):634, 29 August 2026 — genuinely new, 1 day old Lim (University Hospitals Birmingham) and Schrage (University Heart and Vascular Center Hamburg), et al.
From the abstract:
Cardiogenic shock (CS) is a complex clinical syndrome with a high mortality risk. As heterogeneity of patient presentation is high and diagnosis not standardized, a timely diagnosis and thus initiation of treatment are oftentimes not achieved, further worsening the prognosis of affected patients. We therefore propose standardized criteria for the diagnosis of cardiogenic shock, based on three essential pillars: (i) an evidence of end-organ hypoperfusion at rest, (ii) which is primarily caused by haemodynamic abnormalities and a direct consequence of (iii) an underlying cardiac dysfunction commensurate with the state of shock.
All three components are mandatory:
1 · Cardiac dysfunction — severe ventricular dysfunction, severe valvular disease, or a mechanical complication; obstructive shock excluded.
2 · Haemodynamic abnormality — at least two of three:
- hypotension (SBP <90 mmHg or MAP <65 mmHg for >30 min, or maintained only on vasoactive drugs)
- elevated filling pressures
- low cardiac index (<2.2 l·min⁻¹·m⁻²)
3 · Hypoperfusion at rest — at least one clinical sign (skin changes, altered mental status, oliguria) plus one metabolic parameter (lactate
2.0 mmol/L, low oxygen saturation, base excess deficit, renal dysfunction markers, hepatic injury, spontaneous hypoglycaemia, or CO₂ gradients).
Interpretation. The pointed part is what this excludes. The document notes that SCAI’s pragmatic and clinical-trial definitions permit inclusion of patients without clear evidence of hypoperfusion — and the European proposal’s central move is to make resting hypoperfusion mandatory rather than optional. In practice that removes the normotensive-but-labelled and the hypotensive-but-well-perfused from the diagnosis.
That matters most for trials. A decade of cardiogenic shock research has struggled with heterogeneous enrolment, and if a substantial fraction of enrolled “shock” patients were not actually hypoperfused, the dilution would plausibly explain some of the field’s flat results. Requiring one clinical and one metabolic marker is a higher bar than most registries have applied.
Read it against the Bohula and Morrow vasoactive primer from yesterday’s brief — that paper argued for defining the haemodynamic phenotype before choosing a drug, and this one supplies the entry criteria for being in the room at all. Between them the message is consistent: the field’s problem has been that “cardiogenic shock” named too many different patients at once.
Note also the three-society authorship — acute cardiovascular care, heart failure and interventional cardiology together — which is how a definition gets adopted rather than debated.