Background: Cardiogenic shock (CS) imparts a high mortality rate, yet a standardized classification of its severity remains lacking. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a five-stage classification scheme to improve risk stratification, but its prognostic value in real-world intensive care unit (ICU) populations is still insufficiently validated.Methods: We retrospectively analyzed 3,074 adults admitted to the medical and cardiovascular ICUs under the Division of Cardiology at a tertiary academic medical center between 2010 and 2019. SCAI shock stages (A–E) were assigned at admission using data on hemodynamic instability, hypoperfusion, clinical deterioration, and refractory shock. The primary outcome was ICU mortality.Results: ICU mortality rates across stages A–E were 0.5%, 4.3%, 5.2%, 18.8%, and 53.2% (P<0.001). Compared to stage A, higher stages were independently associated with mortality (adjusted odds ratio, 3.93–31.58). The discriminatory ability of the SCAI CS classification was moderate (area under the receiver operating characteristic curve AUROC, 0.787) but improved markedly with the addition of Acute Physiology and Chronic Health Evaluation II scores (AUROC, 0.929).Conclusions: The SCAI CS classification offers clear, incremental risk stratification of ICU mortality. When combined with global severity scores, it provides superior prognostic accuracy, supporting its routine use in the management and study of CS.
Cho et al. (Fri,) studied this question.