A significant unmet need is the risk-stratification of patients with cardiogenic shock (CS). There were inconsistent criteria defining each stage in the recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) staging system for the severity of CS. For a study, researchers assessed the variables that constituted the SCAI phases and investigated their potential as CS in-hospital mortality predictions.

Clinical profiles for CS were developed using data from the CS Working Group registry, which comprised patients from 17 hospitals enrolled between 2016 and 2021. They chose treatment intensity, hypotension, and hypoperfusion characteristics and verified each one’s link to mortality. Next, they established formal standards for each stage and looked at the link between baseline and maximum Stage and death.

In the study, 52% of the 3,455 patients with CS had heart failure or myocardial infarction (32%). Death rates were greater in patients with myocardial infarction, out-of-hospital cardiac arrest, and therapy with an increasing number of drugs and devices, with the cohort seeing a mortality rate of 35%. Systolic blood pressure, lactate level, alanine transaminase level, and systemic pH were utilized to categorize each stage since they were all strongly linked with death. These criteria revealed a significant correlation between baseline and maximal phases and mortality (n=1,890). In addition, the incidence of stage escalation was higher, and the time it took to reach the maximum stage was shorter when the baseline stage was lower.

They provided a unique method for defining SCAI stages and found a strong correlation between mortality and baseline and maximal stage. The strategy offered a fresh perspective on the hospitalization trajectory of CS patients and may enhance the therapeutic use of the staging system.

Reference: jacc.org/doi/10.1016/j.jacc.2022.04.049