Application of the Updated Cardiogenic Shock Working Group SCAI Classification for Cardiogenic Shock: A Single-Center Analysis.

Background: In 2019, the Society for Cardiovascular Angiography and Interventions (SCAI) proposed an algorithm to assess cardiogenic shock (CS) severity, known as SCAI classification (1). In 2022, the Cardiogenic Shock Working Group (CSWG) modified the original classification using specific parameters to better define hypotension and hypoperfusion with the goal to further refine stratification (2).

Methods: Consecutive patients with CS managed at a quaternary academic medical center from May 2015 to December 2021 were evaluated (N=1,162). Our study cohort comprised patients who developed CS after admission. In-hospital mortality per SCAI stage at shock onset was assessed. The percentages of tMCS use per SCAI stage at shock onset was also reported. In our study, we included intra-aortic balloon pump (IABP), percutaneous ventricular assist device (pVAD), and veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Results: Our study cohort comprised 742 patients with a median age of 62.0 years (interquartile range 51-72), mostly male (66%). Etiology of CS included 25% being acute myocardial infarction (AMI) and 75% being non-AMI. In-hospital mortality per CS severity stage via SCAI-CSWG classification was 14.30% for stage B, 20.90% for stage C, 32.70% for stage D, and 44.80% for stage E while tMCS utilization was greatest in SCAI Stage E.

Conclusions: We identified a direct relationship of in-hospital mortality per CS severity stage via SCAI-CSWG classification in the overall cohort. These findings require further validation in prospective studies.