The incidence of cardiogenic shock will not decrease until the main cause, which is obstruction to coronary arteries by atheromatous plaque and thrombosis, is arrested. Thrombolytic therapy is of little value and revasculariza-tion with balloon angioplasty and coronary bypass surgery can only be undertaken in special centers. The SHOCK trial only studied 300 patients. More research is required to assess if we could develop cardioactive agents to protect the myocardium from necrosis during an occlusion of a coronary artery.