SCAI Shock Stages A Through E

SCAI Shock Stages A Through E

The Society for Cardiovascular Angiography and Intervention (SCAI) has classified cardiogenic shock into stages from A through E. This was developed by a multidisciplinary team from cardiology (interventional, advanced heart failure and noninvasive), emergency medicine, critical care and cardiac nursing.

Stage A: “At risk” for cardiogenic shock – large myocardial infarction or heart failure, but not yet in shock, with normal mentation and systolic blood pressure of 100 mm Hg or more.

Stage B: “Beginning” shock – hypotension or tachycardia without features of hypoperfusion (normal mentation). Systolic BP < 90, mean arterial pressure (MAP) <60 or 30 mm Hg fall in BP.

Stage C: “Classic” cardiogenic shock – has hypotension with features of hypoperfusion, needing inotropes and mechanical circulatory support.

Stage D: “Deteriorating” – needs multiple inotropes or mechanical circulatory support to maintain perfusion. Initial interventions have failed.

Stage E: “Extremis” – in cardiac arrest with ongoing CPR or ECMO support, nearly pulseless, hypotension despite maximal support.

This is a brief description of the stages. More detailed description is available in the SCAI statement (Free Full Text).

A study from Mayo Clinic retrospectively classified patients who were admitted in cardiac intensive care unit between 2007 and 2015 [2]. Of the total 10,004 patients, 43.1% had acute coronary syndrome, 46.1% had heart failure, and 12.1% had cardiac arrest. 46% of the patients were in stage A and 1% in stage E with others in between. Unadjusted hospital mortality was 3% in stage A and 67% in stage E, with others in between. When assessed at the time of admission to cardiac intensive care unit, the SCAI shock stage provided robust hospital mortality risk stratification.

References

1. Baran DA, Grines CL, Bailey S, Burkhoff D, Hall SA, Henry TD, Hollenberg SM, Kapur NK, O’Neill W, Ornato JP, Stelling K, Thiele H, van Diepen S, Naidu SS. SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv. 2019 Jul 1;94(1):29-37.
2. Jentzer JC, van Diepen S, Barsness GW, Henry TD, Menon V, Rihal CS, Naidu SS, Baran DA. Cardiogenic Shock Classification to Predict Mortality in the Cardiac Intensive Care Unit. J Am Coll Cardiol. 2019 Oct 29;74(17):2117-2128.