Exploration of the Clinical Assessment and Prognostic Value of Society for Cardiovascular Angiography and Intervention Shock Staging in Patients With Acute Myocardial Infarction and Cardiogenic Shock on Veno-arterial Extracorporeal Membrane Oxygenation Support.

BACKGROUND

Although the Society for Cardiovascular Angiography and Intervention (SCAI) five-stage system provides a structured approach to shock assessment, the prognostic utility of this system in patients with acute myocardial infarction and cardiogenic shock (AMICS) supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO), particularly when combined with dynamic cardiac biomarkers, has not been fully validated.

METHODS

This single-center, hospital-based, prospective registry study, we continuously enrolled patients with AMICS who received VA-ECMO support at the Cardiac Centre of the First Hospital of Lanzhou University between January 2020 and October 2023, using data from the Chinese Society of Extracorporeal Life Support (CSECLS) registry. Patients were assigned to Stage D or E groups according to the SCAI shock staging system. Clinical characteristics and biomarkers were compared between the two groups, and a multivariate logistic regression model was used to examine the associations among shock stage, cardiac biomarkers, and in-hospital mortality.

RESULTS

This study included 119 patients with AMICS receiving VA-ECMO support, of whom 78 were classified as Stage D and 41 as Stage E. Compared with Stage D patients, Stage E patients had lower VA-ECMO survival scores (-10 vs -2; p < 0.001), left ventricular ejection fraction (EF) (0.26 vs 0.33, p = 0.050), and high-density lipoprotein cholesterol (HDL-C) levels (0.78 vs 0.89; p = 0.013). However, Stage E patients had a higher incidence of ventricular tachycardia and fibrillation (53.7% vs 34.6%, p = 0.045), as well as higher glucose levels (14.85 vs 9.54; p = 0.016), triglyceride-glucose index (2.29 vs 1.72, p = 0.011) and lactate concentration (12.9 vs 9.1; p = 0.016). Cardiac troponin I, myoglobin and creatine kinase-MB levels, as well as the associated temporal variation patterns, differed significantly between the two groups. In-hospital mortality rate was significantly higher in Stage E patients than in Stage D individuals (78% vs 53.8%; p = 0.010). Multivariate logistic regression analysis showed that combining SCAI shock staging with age, troponin I 6-0, and myoglobin 24-0 significantly improved the prediction of mortality risk (area under the receiver operating characteristic (ROC) curve = 0.791). The 1-year follow-up survival rate was higher in Stage D patients (37.2%) than in Stage E individuals (19.5%).

CONCLUSION

Combining SCAI shock staging with the dynamic monitoring of cardiac biomarkers facilitates the early risk stratification in patients with AMICS receiving VA-ECMO support, and demonstrates good predictive value for in-hospital mortality.