SCAI cardiogenic shock classification for predicting short-term mortality in acute myocardial infarction

Background: Cardiogenic shock (CS) remains a critical complication of acute myocardial infarction (AMI) with severe outcomes. The Society for Cardiovascular Angiography and Interventions (SCAI) classification is a valuable tool for assessing the severity and progression of CS. Objectives: Our study aimed to evaluate the association between initial SCAI classification and 30-day mortality in AMI patients and assess the prognostic value of SCAI changes within 24 hours post-admission. Methods: All patients with AMI were classified according to the SCAI stages at admission and re-evaluated after 24 hours. 30-day mortality rates were compared across SCAI stages, and Cox regression analysis was used to assess the risk of death based on 24-hour transition SCAI classification. Results: At admission, among 232 AMI patients, 50.8% were classified as SCAI A, 21.6% as SCAI B, 23.3% as SCAI C, and 4.3% as SCAI D/E. The 30-day mortality rates for each classification were 1.7% for SCAI A, 30.0% for SCAI B, 68.5% for SCAI C, and 90% for SCAI D/E. Within 24 hours of admission, 14.5% of patients experienced a worsening SCAI stage, 73.4% remained unchanged SCAI, and 12.1% showed improved SCAI. Patients with a worsening SCAI classification had a significantly higher risk of 30-day mortality, with an adjusted hazard ratio (HR) of 50.4 compared to those with stable SCAI status (p log-rank = 0.00001). Conversely, patients with stable or improved SCAI stages had notably lower mortality rates. Conclusion: The initial SCAI stage at admission and its changes within 24 hours are crucial predictors of 30-day mortality in AMI patients with CS.