Background: Cardiogenic shock occurs most commonly in association with, and as a direct result of acute myocardial infarction (AMI). In the patients who exposed in shock, the mortality will be increased. We would like to investigate the causes of death in acute stage of AMI and factors which could effect to cardiogenic shock. Methods: Since 1997 to 2006, one hundred fifty nine patients were expired in acute stage of AMI (within 7 days after AMI attack). We retrospectively reviewed the medical records. Cardiogenic shock was defined as sustained hypotension (systolic blood pressure less than 90 mm Hg, lasting more than 30 minutes) with evidence of tissue hypoperfusion, which was defined as cold peripheries, oliguria, or both. Results: Among the 159 expired patients, the incidence of cardiogenic shock was 88.6% (141 patients). Other causes were gastro-intestinal bleeding (4 patients, 2.5%), Cerebro-vascular Accident (3 patients, 1.9%), and etc (sepsis, wound bleeding, respiratory failure: 11 patients, 6.9%). In cardiogenic shock group, mean pain to door time was 13.7짹10.2 hours. In this expired patients, primary coronary intervention was performed just in 21.5%. Conclusion: As the published data, the most common cause of death is cardiogenic shock. The cardiogenic shock was fatal, even with treatment. The longer pain to door time might increase the incidence of cardiogenic shock and its mortality. Early assessment and mechanical reperfusion therapy in AMI with cardiogenic shock might increase the survival.