Cardiogenic shock (CS) is a low cardiac-output state resulting in end-organ hypoperfusion and hypoxia that if untreated leads to an irreversible condition of multi-organ failure. Acute coronary syndrome (ACS) is the most common cause of CS, with a high prevalence of patients with multi vessels disease. Cardiogenic shock management remains a challenge since mortality rates are still high and have not declined over the last 20 years. The treatment strategy of CS in patients with ACS needs to take into account both the presence of myocardial ischemia and tissue hypoperfusion. The first part of the review will focus on the characteristics, the hemodynamic profile and the evidence available of the mechanical circulatory support devices for an optimal patient-device matching. The second part will focus on the management strategy of CS in terms of myocardial revascularization and hemodynamic support in light of the most recent available evidence.