Short-term Outcome of Patients with Acute Myocardial Infarction and SCAI-classified Cardiogenic Shock: An Egyptian Registry

Background and Aim: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with high morbidity and mortality. The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification provides a structured approach to risk stratification. This study examines the predictors of in-hospital and 30-day mortality among AMI-CS patients using the SCAI staging classification. Materials and Methods: A prospective cohort study was conducted on 150 patients admitted with AMI-CS at Department of Cardiology, Ain Shams University Hospitals from November 2023 to August 2024. Patients were categorized into SCAI stages (A to E) at presentation and reassessed 24 hours later. Demographic, clinical, biochemical, and hemodynamic parameters were collected. Results: At presentation, 35.3% of patients were in stage A, 4% in stage B, 54.7% in stage C, 4.7% in stage D, and 1.3% in stage E. Overall in-hospital and 30-day mortalities were 28.7% and 37.3%, respectively. Higher SCAI stages correlated with increased mortality (P < 0.001). Independent predictors of mortality included a Sequential Organ Failure Assessment score greater than 5 [odds ratio (OR) =8.17, P < 0.001], an APACHE score greater than 7 (OR =3.71, P = 0.008), and a serum creatinine level greater than 1.53 mg/dL (OR =5.37, P = 0.005). The SCAI score at 24 hours demonstrated superior predictive accuracy for in-hospital mortality (area under the curve =0.889). Conclusions: SCAI staging is a valuable prognostic tool for MI patients with CS. Reassessment at 24 hours enhances mortality prediction, emphasizing the importance of dynamic risk stratification.