Deterioration of cardiogenic shock after acute myocardial infarction defined by the society for cardiovascular angiography and intervention cardiogenic shock classification scheme

Abstract Background Cardiogenic shock (CS) in patients with AMI presents worse cardiovascular outcomes, which suggests the need for better risk stratification and management. The Society Cardiovascular Angiography Intervention (SCAI) has recently proposed CS classification scheme, stratifies into 5 groups according to hypotension hypoperfusion. While stage A B exhibits without and/or hypoperfusion, their clinical condition could rapidly deteriorate C-E. However, characteristics in-hospital outcomes of exhibiting its deterioration remains uncertain. Purpose To characterize who deteriorated status from Methods This single-center observational study included 326 consecutive receiving primary PCI presented on arrival (2019.09.01–2021.09.30). Deterioration (D-CS) was defined as progression C-E after PCI. Clinical were compared those D-CS. Results D-CS identified 16.0% entire subjects (=52/326). Of these, 94.2 5.8% them exhibited C E, respectively (Figure). Patients more likely STEMI (84.6 vs. 67.9%, p=0.01) a lower systolic BP (sBP) level (130±31 148±26mmHg, p<0.001) reduced LVEF (43±13 51±9%, p<0.001), whereas there no significant difference lactate (1.5±0.4 1.2±0.3 mmol/L, p=0.22). Pre-TIMI flow grade 0–1 (69.2 47.8%, p=0.006), left main trunk stenosis (9.6 1.5%, p=0.007) chronic total occlusion (21.2 8.4%, frequently observed Despite achieving shorter onset-to-reperfusion time (199 276 minutes, p=0.002), associated all-cause mortality adjusting (HR=33.6, 95% CI: 2.2–502.0, p=0.01). Furthermore, mechanical circulatory support (MCS) (30.8 0%, required (IABP: 28.8 p<0.001, ECMO: 11.5 Impella: 3.8 p=0.02). Further analysis sBP (HR=0.98, 0.97–1.00, p=0.008), (HR=0.94, 0.90–0.97, pre-TIMI (HR=0.41, 0.19–0.86, independent contributors ROC demonstrated <135 mmHg (AUC=0.65) <50% (AUC=0.69) best cut-off values predict note, increased association number these three factors (p<0.001), 44.0% all Conclusion any hypotension/hypoperfusion SCAI classification. combination sBP, help identify D-CS, may benefit early adoption intensified management including MCS prior Funding Acknowledgement Type funding sources: None.