Serial shock severity assessment within seventy-two hours after diagnosis: a cardiogenic shock working group report

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 illustrating progressive changes in SCAI stages and outcomes are limited.

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

The multi-center CSWG registry was queried. CSWG-SCAI stages were computed at CS diagnosis (baseline, 0 hour) and subsequently at 24, 48, and 72 hours.

A total of 3268 patients (57% HF-CS, 27% MI-CS) were included. On admission, CSWG-SCAI stage breakdown was: 593 (18.1%) B, 528 (16.2%) C, 1659 (50.8%) D, and 488 (14.9%) non-cardiac arrest stage E (Fig. A). 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 change in SCAI stages occurred beyond 24 hours. SCAI stage trajectories were similar between MI-CS and HF-CS groups. Notably, stage B patients who worsened to stage C had similar mortality to those remaining at stage C (25.9% vs. 15.8%, p=0.1). Stage B patients worsening to stage D also had similar mortality to stage C patients worsening to stage D (27.4% vs. 25%, p=0.6) (Fig. B). Stage B subjects who remained at stage B by 24 hours still had a 20% in-hospital mortality. Patients who presented in or progressed to stage E by 24 hours had the highest rates of mortality.

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.