Background Cardiogenic shock (CS) after acute myocardial infarction (AMI) represents the most severe form of acute heart failure (AHF) syndromes with an high rate of in-hospital mortality. Purpose describe predictors of in-hospital mortality; evaluate ten years mortality temporal trend in our CICU; assess the feasibility of CARDSHOCK risk score; elaborate a simpler version of CARDSHOCK risk score. Methods All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single-centre retrospective study. Results We included 167 patients [males 67%; age 71 years] with ischemic CS. Patients had severe LV dysfunction in 66%. Baseline serum lactate was 5,2 mmol/L. All patients required inotropes: 71% required dopamine, 65% noradrenaline, 32% dobutamine; 32% adrenalina,17,4% received levosimendan alone. Mechanical cardiac support (MCS) was pursued in 91,1% [65% IABP, 23% Impella CP, 4% VA-ECMO]. From March 2012 to July 2021 we observed a significative temporal trend mortality reduction (p=0.0015) from 57% of first time-quartile to 29% of the fourth quartile (fig1). In addition we noted a significant increase in Impella catheter use (p=0,0005) with a consequent reduction of IABP (p=0,01), a reduction in dopamine administration (p=0,007) and a greater use of inotropic drugs with vasodilatory action (p=0,015 and p=0,001). In our population of AMI-CS patients CARDSHOCK risk score was a reliable in-hospital mortality predictor tool (p=0.00011). After the multivariate analysis only EF at baseline (p=0,009), lactate level at presentation (p=0,015) and presence of three-vessels CAD (p=0,0038) resulted to be in-hospital mortality predictors. A new prediction model composed by those three variables was created and it exhibited better predictive performance for in-hospital mortality than Cardshock risk score (AUC 0,94 vs 0,72 respectively, p=0,015) (fig2). Conclusions In our retrospective single-centre study a significant reduction of mortality through the years is observed, probably due to more extensive use of micro axial pumps and a greater use of inodilators drug therapies. Cardshock risk score represents a feasible tool to predict in-hospital mortality also in our sample composed only of ischemic CS patients. A new prediction model composed by three clinical variables demonstrates at least the same predictive performance but future validation in a larger population could be advisable to validate the simplified score.