Little data exist about current treatment strategies the efficacy of thrombolytic therapy and outcome of patients with acute myocardial infarction (AMI) presenting in cardiogenic shock (CS). Data from the German multicenter "60 Minutes Myocardial Infarction Project" were used to analyze a large number of patients with AMI and CS on admission and to compare those to patients without CS. Between July 1993 and September 1994 a total of 7,085 patients with AMI were registered. Out of these, 179 patients (2.5%) presented in CS (systolic blood pressure < 100 and heart rate > 100/min, resuscitated patients were excluded). Patients in CS were significantly older than patients without CS. Their in-hospital mortality was 47.1% compared with 12.4% in patients without CS (p = 0.001). The prevalence of the following clinical parameters was significantly higher in patients with CS than in those without CS: bundle branch block, prior MI, and a non-diagnostic ECG (all p < 0.05). Thrombolytic therapy was used in 36.3% of patients in CS and in 50.8% of those without CS (p = 0.001). The in-hospital mortality in patients with CS receiving thrombolytic therapy was significantly lower than in patients with CS who did not receive thrombolytic agents (33.3% versus 55.1%; p = 0.006). In daily clinical practice in Germany thrombolytic treatment is used in only 36.3% of patients with AMI presenting in CS on admission. The use of thrombolysis in CS on admission is associated with a lower in-hospital mortality.