Journal Article

Prognostic Impact of SCAI Shock Severity Classes in AMI-Related Cardiogenic Shock: A Sub-Study of the ECLS-SHOCK Trial

Feistritzer, Hans-Josef, Thevathasan, Tharusan, Pöss, Janine, Desch, Steffen, Ouarrak, Taoufik, Rassaf, Tienush, Jung, Christian, Zeymer, Uwe, Jentzer, Jacob, Schneider, Steffen, Thiele, Holger, Freund, Anne, Roßberg, Michelle, Akin, Ibrahim

2025

Overview

Abstract Aims The Society for Cardiovascular Angiography and Interventions (SCAI) Classification provides risk stratification of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This sub-study of the ECLS-SHOCK trial investigates the prognostic impact of SCAI stages in AMI-CS and the influence of SCAI stages on the effect of extracorporeal life support (ECLS) therapy in AMI-CS patients. Methods Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial were included. The outcomes, treatment effect and safety of ECLS were stratified according to SCAI stage at admission using a post-hoc classification. Results From a total of 417 patients enrolled in the ECLS-SHOCK trial between June 2019 and November 2022, 51.6% (n = 215), 13.4% (n = 56) and 35.0% (n = 146) presented in SCAI Stages C, D and E, respectively. SCAI stages were associated with the risk of 30 day all-cause mortality (C vs. D vs. E: 32.6% vs. 67.9% vs. 64.4%, P < 0.001), with rates of renal replacement therapy at 30 days (C vs. D vs. E: 7.0% vs. 19.6% vs. 13.7%, P = 0.03) and with poor neurological outcomes (C vs. D vs. E: 17.2% vs. 44.4% vs. 36.5%, P < 0.001). No interaction was observed between SCAI stage and the treatment effect of ELCS on 30 day all-cause mortality (ELCS vs. control SCAI C: 32.7% vs. 32.4%; SCAI D: 68.4% vs. 66.7%; SCAI E: 59.7% vs. 68.4%, P for interaction = 0.65). Conclusions In AMI-CS patients included in the ECLS-SHOCK trial, SCAI stages at admission were predictive for mortality and for the incidence of safety events. The efficacy of ECLS treatment was not affected by SCAI stage. Patients with AMI-CS (lactate >3 mmol/L) enrolled in the multicentre, randomized ECLS-SHOCK trial were included. From a total of 417 patients, 51.6% (n = 215), 13.4% (n = 56) and 35.0% (n = 146) presented in SCAI Stages C, D and E, respectively. SCAI stages were associated with the risk of 30 day all-cause mortality, with rates of renal replacement therapy at 30 days and with poor neurological outcomes. No interaction was observed between SCAI stage and the treatment effect of ELCS on 30 day all-cause mortality.

• Publisher: Oxford University Press,Wiley
• Subject: acute myocardial infarction / Aged / Blood pressure / cardiogenic shock / Cardiopulmonary resuscitation / Cardiovascular disease / CPR / extracorporeal life support / Extracorporeal Membrane Oxygenation - methods / Female / Follow-Up Studies / Heart attacks / Humans / Male / Medical history / Medical imaging / Medical treatment / Middle Aged / Mortality / Myocardial Infarction - complications / Myocardial Infarction - therapy / Oliguria / Original / Prognosis / Renal replacement therapy / Risk Assessment - methods / Severity of Illness Index / Shock, Cardiogenic - classification / Shock, Cardiogenic - diagnosis / Shock, Cardiogenic - etiology / Shock, Cardiogenic - mortality / Shock, Cardiogenic - therapy / Society for Cardiovascular Angiography and Interventions / Survival Rate - trends / Vein & artery diseases