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. 2024 Aug 1:S0735-1097(24)07740-4.
doi: 10.1016/j.jacc.2024.04.069. Online ahead of print.

Serial Shock Severity Assessment Within 72 Hours After Diagnosis: A Cardiogenic Shock Working Group Report

Van-Khue Ton  1 , Song Li  2 , Kevin John  3 , Borui Li  3 , Elric Zweck  4 , Manreet K Kanwar  5 , Shashank S Sinha  6 , Jaime Hernandez-Montfort  7 , A Reshad Garan  8 , Rachel Goodman  3 , Anthony Faugno  3 , Maryjane Farr  9 , Shelley Hall  10 , Rachna Kataria  11 , Maya Guglin  12 , Esther Vorovich  13 , Mohit Pahuja  14 , Saraschandra Vallabhajosyula  11 , Sandeep Nathan  15 , Jacob Abraham  16 , Neil M Harwani  3 , Gavin W Hickey  17 , Andrew D Schwartzman  18 , Wissam Khalife  19 , Claudius Mahr  2 , Ju H Kim  20 , Arvind Bhimaraj  20 , Paavni Sangal  3 , Qiuyue Kong  3 , Karol D Walec  3 , Peter Zazzali  3 , Justin Fried  21 , Daniel Burkhoff  22 , Navin K Kapur  23
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Free article

Serial Shock Severity Assessment Within 72 Hours After Diagnosis: A Cardiogenic Shock Working Group Report

Van-Khue Ton et al. J Am Coll Cardiol. .
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Am Coll Cardiol. 2025 Mar 25;85(11):1288. doi: 10.1016/j.jacc.2025.02.017. J Am Coll Cardiol. 2025. PMID: 40107817 No abstract available.

Abstract

Background: The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging was developed to risk stratify cardiogenic shock (CS) severity. Data showing progressive changes in SCAI stages and outcomes are limited.

Objectives: We investigated serial changes in CSWG-SCAI stages and outcomes of patients presenting with cardiogenic shock complicating acute myocardial infarction (MI-CS) and heart failure-related CS (HF-CS).

Methods: The multicenter CSWG registry was queried. CSWG-SCAI stages were computed at CS diagnosis and 24, 48, and 72 hours.

Results: A total of 3,268 patients (57% HF-CS; 27% MI-CS) were included. At CS diagnosis, CSWG-SCAI stage breakdown was 593 (18.1%) stage B, 528 (16.2%) stage C, 1,659 (50.8%) stage D, and 488 (14.9%) noncardiac arrest stage E. At 24 hours, >50% of stages B and C patients worsened, but 86% of stage D patients stayed at stage D. Among stage E patients, 54% improved to stage D and 36% stayed at stage E by 24 hours. Minimal SCAI stage changes occurred beyond 24 hours. SCAI stage trajectories were similar between MI-CS and HF-CS groups. Within 24 hours, unadjusted mortality rates of patients with any SCAI stage worsening or improving were 44.6% and 34.2%, respectively. Patients who presented in or progressed to stage E by 24 hours had the worst prognosis. Survivors had lower lactate than nonsurvivors.

Conclusions: Most patients with CS changed SCAI stages within 24 hours from CS diagnosis. Stage B patients were at high risk of worsening shock severity by 24 hours, associated with excess mortality. Early CS recognition and serial assessment may improve risk stratification.

Keywords: Society for Cardiovascular Angiography and Interventions stages; cardiogenic shock; mortality; serial assessment; shock progression.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by institutional grants from Abiomed Inc, Boston Scientific Inc, Abbott Laboratories, Getinge Inc, and LivaNova Inc to Tufts Medical Center. The sponsors had no input on collection, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript. Dr Kanwar has served on the advisory boards for Abiomed Inc, Abbott Laboratories, and CorWave. Dr Sinha has received consulting fees from Abiomed Inc. Dr Hernandez-Montfort has received consulting fees from Abiomed Inc. Dr Garan has received consulting fees from NuPulseCV; has been on the scientific advisory board for Abiomed; and has received research support from Verantos and Abbott. Dr Hall has received consulting fees from Abiomed, Abbott, and Medtronic. Dr Vorovich has received consulting fees from and has served on the speaker bureau for advisory board and steering committee for Abiomed, Inc; has received speaker’s fees from Abbott Laboratories; and has served on the advisory board for Novo Nordisk A/S. Dr Nathan has received consulting fees from Abiomed, Getinge, and CSI. Dr Abraham has received consulting fees from Abbott Laboratories and Abiomed Inc. Dr Mahr has received consulting fees from Abbott, Abiomed, and Syncaria. Dr Burkhoff has received an unrestricted educational grant from Abiomed Inc. Dr Kapur has received consulting fees and institutional grant support from Abbott Laboratories, Abiomed Inc, Boston Scientific, Medtronic, LivaNova, Getinge, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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