In-Hospital and Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction Categorized as SCAI Shock Stage B

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Myocardial Infarction (AMI) (n=257). Intervention: SCAI shock modified stage B vs. SCAI shock modified stage A. Primary outcome: In-hospital adverse events (composite of in-hospital death, initiation of mechanical circulatory support, and mechanical complications) (OR 1.690, 95% CI 0.747-3.826, p=0.208).

Hisashi Sato; Kenichi Sakakura; Hiroyuki Jinnouchi; Yousuke Taniguchi; Kei Yamamoto; Takunori Tsukui; Masashi Hatori; Taku Kasahara; Yusuke Watanabe; Shun Ishibashi; Masaru Seguchi; Hideo Fujita

doi:10.1253/circrep.cr-25-0270

April 8, 2026Circulation ReportsOpen Access

In-Hospital and Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction Categorized as SCAI Shock Stage B

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Key result

SCAI shock modified stage B was not independently associated with an increased risk of in-hospital adverse events (OR 1.690) compared to modified stage A in patients with acute myocardial infarction.

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Why the study?

Mortality in AMI complicated by cardiogenic shock remains high despite MCS advances, prompting comparison of outcomes between SCAI shock stage A and stage B patients.

Do in-hospital and long-term clinical outcomes differ between acute myocardial infarction patients categorized as SCAI shock stage B versus stage A?

Key Points

To compare the clinical characteristics and outcomes of acute myocardial infarction patients presenting with SCAI shock stage A versus stage B.
Retrospective single-center study evaluating 257 acute myocardial infarction patients admitted between January 2015 and December 2023.
Patients were categorized into modified SCAI stage A (n=180) and modified SCAI stage B (n=77) cohorts based on admission parameters.
Modified stage B patients had significantly lower left ventricular ejection fraction (44.6±14.3% vs. 56.4% (45.5–64.1%), P<0.001) and lower estimated glomerular filtration rate (49.9 (31.9–70.5) vs. 64.7 (44.5–82.5) mL/min/1.73 m2, P=0.008) than stage A patients.
Median B-type natriuretic peptide levels were significantly higher in stage B compared to stage A (517.6 (155.1–1,200.5) vs. 72.0 (32.3–308.1) pg/mL, P<0.001), alongside higher pulse rates (109 (102–122) vs. 72.0 (64.0–84.8) beats/min, P<0.001).

Study Design

Type

Cohort (n=257)

Multicenter

No

Structured PICO

Do in-hospital and long-term clinical outcomes differ between acute myocardial infarction patients categorized as SCAI shock stage B versus stage A?

P

Population

Patients with acute myocardial infarction (AMI)

I

Intervention

SCAI shock stage B classification

C

Comparator

SCAI shock stage A classification

O

Outcome

In-hospital and long-term clinical outcomes

Main Result

Effect estimate: OR 1.690 (95% CI 0.747-3.826)

Absolute Event Rate: 15.6% vs 8.9%

p-value: p=0.208

Limitations

Single-center retrospective observational study design introduces inherent risk of selection bias
Arbitrary selection of variables for the multivariate Cox hazard model
Exclusion of many cases due to lack of routinely measured lactate levels
Relatively small sample size increasing the possibility of type 2 error
Initiation of MCS as an endpoint component might not be objective and could be influenced by clinical practice patterns
Physical examination findings were not incorporated into the classification process, risking misclassification
Venous lactate levels were substituted for arterial ones in some cases
Serial lactate measurements were not routinely performed to assess stage transition
eGFR was calculated from admission serum creatinine, which could be influenced by hemodynamic status

Discussion

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Implication

Should not alter management for modified SCAI stage B versus A in AMI; leaves open independent prognostic contribution of staging and needs prospective confirmation.

Abstract

Background: The mortality rate for acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) remains high despite advances in mechanical circulatory support (MCS). The Society for Cardiovascular Angiography and Interventions (SCAI) has proposed a 5-stage classification of CS, and in this study we compared the clinical outcomes of AMI patients with SCAI shock stage A with those in stage B.

Cite This Study

Sato et al. (2026) conducted a cohort in Acute Myocardial Infarction (AMI) (n=257). SCAI shock modified stage B vs. SCAI shock modified stage A was evaluated on In-hospital adverse events (composite of in-hospital death, initiation of mechanical circulatory support, and mechanical complications) (OR 1.690, 95% CI 0.747-3.826, p=0.208). SCAI shock modified stage B was not independently associated with an increased risk of in-hospital adverse events (OR 1.690) compared to modified stage A in patients with acute myocardial infarction.

synapsesocial.com/papers/69d9e4d578050d08c1b752b5 https://doi.org/10.1253/circrep.cr-25-0270

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In-Hospital and Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction Categorized as SCAI Shock Stage B

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

In-Hospital and Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction Categorized as SCAI Shock Stage B

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

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