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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Prognostic impact of SCAI shock severity classes in AMI-related cardiogenic shock: A sub-study of the ECLS-SHOCK

Janine Pöss1, Jacob Jentzer2, Steffen Desch1

  • 1Heart Center Leipzig, Leipzig University and Leipzig Heart Science, Leipzig, Germany.

ESC Heart Failure
|October 13, 2025
PubMed

Insights

The Society for Cardiovascular Angiography and Interventions (SCAI) classification effectively predicts mortality and safety events in acute myocardial infarction with cardiogenic shock (AMI-CS) patients. Extracorporeal life support (ECLS) efficacy remains consistent across all SCAI stages.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Interventional Cardiology

Background:

  • Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is a critical condition requiring precise risk stratification.
  • The Society for Cardiovascular Angiography and Interventions (SCAI) Classification offers a framework for assessing risk in AMI-CS patients.
  • Extracorporeal life support (ECLS) is a vital therapy for severe AMI-CS, but its effectiveness across different risk strata needs evaluation.

Purpose of the Study:

  • To investigate the prognostic value of SCAI classification stages in patients with AMI-CS.
  • To determine if SCAI stages influence the therapeutic effect and safety of ECLS in AMI-CS patients.
  • To analyze the association between SCAI stages and outcomes such as mortality, renal replacement therapy, and neurological status.

Main Methods:

  • A post-hoc analysis was conducted on patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial.
  • Patients were categorized into SCAI stages (C, D, E) at the time of admission.
  • Outcomes, including 30-day all-cause mortality, renal replacement therapy, and neurological outcomes, were assessed and stratified by SCAI stage.

Main Results:

  • SCAI stages C, D, and E were significantly associated with varying risks of 30-day all-cause mortality (32.6%, 67.9%, 64.4%, respectively; P < 0.001).
  • Higher SCAI stages correlated with increased rates of 30-day renal replacement therapy (P = 0.03) and poor neurological outcomes (P < 0.001).
  • No significant interaction was found between SCAI stage and the treatment effect of ECLS on 30-day all-cause mortality (P = 0.65).

Conclusions:

  • SCAI classification at admission is a strong predictor of mortality and safety events in AMI-CS patients within the ECLS-SHOCK trial cohort.
  • The prognostic impact of SCAI stages is evident for mortality, renal replacement therapy, and neurological outcomes.
  • The efficacy of ECLS treatment in AMI-CS patients is not modified by the patient's SCAI stage at admission.
Abstract

Keywords:
Society for Cardiovascular Angiography and Interventionsacute myocardial infarctioncardiogenic shockextracorporeal life support

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