• Patrick R Lawler, David D Berg, Jeong-Gun Park, Jason N Katz, Vivian M Baird-Zars, Gregory W Barsness, Erin A Bohula, Anthony P Carnicelli, Sunit-Preet Chaudhry, Jacob C Jentzer, Venu Menon, Thomas Metkus, Jose Nativi-Nicolau, Nicholas Phreaner, Shashank S Sinha, Jeffrey J Teuteberg, Sean van Diepen, David A Morrow, and Critical Care Cardiology Trials Network Investigators.
• Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
• Crit. Care Med. 2021 Aug 1; 49 (8): 129313021293-1302.

ObjectivesCardiogenic shock presents with variable severity. Categorizing cardiogenic shock into clinical stages may improve risk stratification and patient selection for therapies. We sought to determine whether a structured implementation of the 2019 Society for Cardiovascular Angiography and Interventions clinical cardiogenic shock staging criteria that is ascertainable in clinical registries discriminates mortality in a contemporary population with or at-risk for cardiogenic shock.DesignWe developed a pragmatic application of the Society for Cardiovascular Angiography and Interventions cardiogenic shock staging criteria-A (at-risk), B (beginning), C (classic cardiogenic shock), D (deteriorating), or E (extremis)-and examined outcomes by stage.SettingThe Critical Care Cardiology Trials Network is an investigator-initiated multicenter research collaboration coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions with or at-risk for cardiogenic shock during two annual 2-month collection periods (2017-2019) were analyzed.PatientsPatients with or at-risk for cardiogenic shock.Measurements And Main ResultsOf 8,240 CICU admissions reviewed, 1,991 (24%) had or were at-risk for cardiogenic shock. Distributions across the five stages were as follows: A: 33%; B: 7%; C: 16%; D: 23%; and E: 21%. Overall in-hospital mortality among patients with established cardiogenic shock was 39%; however, mortality varied from only 15.8% to 32.1% to 62.5% across stages C, D, and E (Cochran-Armitage ptrend < 0.0001). The Society for Cardiovascular Angiography and Interventions stages improved mortality prediction beyond the Sequential Organ Failure Assessment and Intra-Aortic Balloon Pumpin Cardiogenic Shock II scores.ConclusionsAlthough overall mortality in cardiogenic shock remains high, it varies considerably based on clinical stage, identifying stage C as relatively lower risk. We demonstrate a pragmatic adaptation of the Society for Cardiovascular Angiography and Interventions cardiogenic shock stages that effectively stratifies mortality risk and could be leveraged for future clinical research.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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