Automated SCAI Staging as a Novel Decision Aid in Cardiogenic Shock Management

Early serial staging of cardiogenic shock (CS) using the Society for Cardiovascular Angiography and Interventions (SCAI) system has prognostic value in retrospective data. The utility of automated SCAI staging as a decision-support tool has not been described.

We aimed to develop an automated, electronic medical record (EMR)-integrated CS staging tool and to assess providers' use of the tool and the associated practice changes.

The 2022 CS Working Group-modified SCAI criteria were translated into an EMR-based score, which automatically stages CS patients every 6 hours. We compared patients' characteristics, SCAI-stage documentation, and CS management before (10/12/22-02/06/24; n = 239) and after (02/07-09/30/24; n = 142) automated staging.

Median age across hospital encounters (n = 381) was 63 years, and 33.6% were women. Heart failure (63.8%) and acute myocardial infarction (14.2%) were the most common CS etiologies. SCAI stage was documented at least once in the Cardiac Intensive Care Unit in 13.0% of preintervention encounters compared with 50.0% following automation (P <0.001). There was a strong time-dependent association between implementing automated staging and increased SCAI stage documentation (P = 0.006). CS surveillance at 72 hours using serial lactate and alanine aminotransferase (ALT) levels also increased from 16.3% to 33.8% and from 17.6% to 26.1% (P < 0.001 for both). In-hospital mortality was 26.0%. Within the automated cohort, 24-hour SCAI stage was associated with likelihood of myocardial recovery (P = 0.001), heart-replacement therapies (P = 0.008), and death (P = 0.067).

Early, serial, automated staging may provide prognostic value to facilitate CS management.