Management and Outcomes of Society for Cardiovascular Angiography and Interventions Stage B Cardiogenic Shock

There are limited data on the etiology, management, and outcomes of Society for Cardiovascular Angiography and Interventions (SCAI) stage B cardiogenic shock.

From 2017 to 2022, adult patients (≥18 years) admitted to the medical, intermediate, and critical care units in a 6-hospital system were evaluated. SCAI stage B cardiogenic shock was defined as hypotension (systolic ≤90/mean ≤65 mm Hg) or hypoperfusion (lactate 2-5 mEq/L). Cardiac arrest, use of circulatory support, and noncardiac etiologies were excluded. The composite primary end point included transfer to a higher level of care, SCAI stage escalation, or in-hospital mortality. Multivariable analysis and mixed-effects regression models were used.

During this period, 500 patients (median age, 76 years; 56% men; 79% White) developed SCAI stage B cardiogenic shock (hypotension 18%, hypoperfusion 82%). The most common etiologies were heart failure (37%), arrhythmia (23%), and acute myocardial infarction (13%). The primary composite end point was noted in 135 patients (deterioration cohort). The deterioration cohort had comparable baseline characteristics to those who recovered, but before the primary outcome, had lower blood pressures, higher rates of renal (60% versus 33%) and hepatic (15% versus 4%) injury, less negative fluid balance (-0.30 versus -0.68 L), and greater diuretic resistance (21% versus 2%; P<0.001). In a multivariable analysis, acute kidney injury-adjusted odds ratio 2.17 (95% CI, 1.11-4.22); P=0.02-and diuretic resistance-adjusted odds ratio 9.55 (95% CI, 2.61-34.89); P=0.001-were independently predictive of clinical deterioration. Patients with isolated hypotension had worse outcomes compared with those with isolated hypoperfusion.

Among patients with SCAI stage B cardiogenic shock, a quarter of the population experienced clinical deterioration. Acute kidney injury and diuretic resistance in the preceding 24 hours were independently predictive of developing the primary end point.