SCAI Presents Late-Breaking Studies of Treatment Protocols for Cardiogenic Shock Patients

April 28, 2021—The Society for Cardiovascular Angiography & Interventions (SCAI) announced that two new studies providing treatment insights for cardiogenic shock (CS) patients were presented as late-breaking clinical science at the SCAI 2021 Virtual Scientific Sessions.

First, a study of the SCAI consensus document on the stages of CS confirmed the accuracy of the shock classification. The second study is an analysis of the National Cardiogenic Shock Initiative, which demonstrated that use of a shock protocol emphasizing early use of mechanical circulatory support (MCS) may lead to improved survival for patients with CS.

In 2019, a joint SCAI consensus statement proposed a new classification system describing the stages of CS, from A to E, to standardize classification of the disease. The document was published by David A. Baran, MD, et al in Catheterization and Cardiovascular Interventions (2019;94:29-37).

Investigators in the first study conducted an analysis of studies in PubMed examining clinical outcomes to understand if the SCAI shock stages provide mortality risk classification. They identified 14 manuscripts of more than 15,000 patients presenting with CS or cardiac arrest (CA) or those admitted to the cardiac intensive care unit. The studies examined seven separate definitions of the SCAI shock stages, and each study demonstrated a stepwise increase in short-term (in-hospital or 30-day) mortality with each higher SCAI shock stage.

According to SCAI, the findings show mortality varying across shock stage (A, 1%-5%; B, 0%-34%; C, 11%-54%; D, 24%-68%; E, 42%-77%) and increased with additional risk factors, including the presence of CA, systemic inflammation, poor hemodynamics, worsening shock, and older age.

“These findings confirm the efficacy of the SCAI shock stage classification, allowing physicians a staged approach to communicate with their colleagues and the broader heart team how sick a patient is in a very consistent way,” commented lead investigator Jacob Jentzer, MD, in the society’s press release. Dr. Jentzer, who is a critical care specialist at Mayo Clinic in Rochester, Minnesota, continued, “Our analysis should enhance physician confidence in the protocol to appropriately identify high-risk and low-risk patients, ultimately helping tailor therapy based on level of shock to improve patient outcomes.”

The National Cardiogenic Shock Initiative, a single-arm, prospective, multicenter study assessing outcomes of early MCS in acute myocardial infarction and CS (AMICS) in patients treated with percutaneous coronary intervention, revealed improved survival rates when using early MCS.

As summarized in the SCAI announcement, 406 patients with AMICS were enrolled at 73 sites between July 2016 and December 2020. The patients were treated using a standard protocol emphasizing invasive hemodynamic monitoring and early initiation of MCS. The average patient age was 64 ± 12 years; 24% were female, and 67% were admitted in shock.

The investigators found that early use of MCS and invasive hemodynamics is associated with an increased patient procedural survival (99%), survival to discharge (79%), survival to 30 days (77%), and survival to 1 year (62%) for patients presenting in stage C/D shock and 98%, 49%, 46%, and 32% for patients in stage E shock (P = .01).

Babar Basir, DO, Director of Acute Mechanical Circulatory Support at Henry Ford Health System in Detroit, Michigan, served as lead author of the study.

“CS is the leading cause of death in heart attack patients and outcomes have not improved over the past two decades,” commented Dr. Basir in the SCAI announcement. “With early use of MCS coupled with hemodynamic monitoring we have the potential to increase survival to 80% and save 20,000 life per year in the United States.”

Study investigators call for further research to build on their findings and connect best practices for different stages of CS. With additional data, investigators hope to provide a benchmark for clinicians to use when treating CS patients, ultimately standardizing care, stated SCAI.