Why is the study important? 

There is limited data on the etiology, management, and outcomes of the Society for Cardiovascular Angiography and Interventions (SCAI) Stage B cardiogenic shock (CS). 

What question is the study supposed to answer? 

This was a retrospective study of patients >=18 years admitted to the medical, intermediate care, and critical care units of a six-hospital healthcare system.  

What did the study show? 

• Between 2017-2022, 431 patients met inclusion criteria for SCAI B CS (hypotension 34%, hypoperfusion 66%). The most common etiologies were heart failure (35%), arrhythmias (22%), acute myocardial infarction (9%), and structural disease (4%).  
• Right-heart catheterization, coronary angiography, and percutaneous coronary intervention were performed in 8.6%, 7%, and 3.5%, respectively. 
• The primary endpoint was noted in 95 (22%): 45.3% transfer to higher level, 61.1% CS deterioration, and 36.8% in-hospital mortality. The median time to the primary endpoint was 16 (IQR 5.5-48) hours. Compared to those without, patients experiencing the primary endpoint had lower admission blood pressure, left ventricular ejection fraction, and 24- hour urine output, with higher acute kidney injury (AKI), bacteremia, and liver injury rates (all p<0.05).   

Key insights

In the largest study of SCAI B CS patients, the most common etiologies were heart failure and arrhythmias. The primary endpoint of care escalation, CS deterioration, or in-hospital mortality was met in 22%. AKI during SCAI B CS was independently predictive of developing the primary endpoint.