Key result
Higher SCAI shock stage at V-A ECMO initiation is linked to up to 57% 90-day mortality.
Why the study?
The prognostic value of the SCAI classification at V-A ECMO initiation and its pattern of risk over time in cardiogenic shock were less well defined.
Does SCAI classification at V-A ECMO initiation stratify 90-day mortality risk in patients with cardiogenic shock?
Cohort (n=80)
No
Does SCAI classification at V-A ECMO initiation stratify 90-day mortality risk in patients with cardiogenic shock?
p-value: p=0.005
SCAI classification assessed at the time of V-A ECMO initiation effectively stratifies 90-day mortality risk in patients with cardiogenic shock.
SCAI staging at V-A ECMO start stratifies 90-day mortality risk in cardiogenic shock; extends prognostic evidence with randomized confirmation.
Background: The Society for Cardiovascular Angiography and Interventions (SCAI) classification grades cardiogenic shock (CS) severity and guides management. Its prognostic value at extracorporeal membrane oxygenation (ECMO) initiation and the pattern of risk over time are less well defined. We examined the association between SCAI classification at veno-arterial (V-A) ECMO initiation and outcomes in adults with CS. Methods: Between January 2019 and December 2025, consecutive patients requiring V-A ECMO for CS at a tertiary ECMO referral centre in Hong Kong were included. SCAI stage was documented at ECMO initiation using consensus criteria. The primary endpoint was 90-day all-cause mortality. Survival was analysed using the Kaplan-Meier curve and log-rank testing. Results: 80 patients were analysed. Median age was 59 [49 – 65] years, and 55 (69%) were male. Acute myocardial infarction (44%), myocarditis (15%) and cardiomyopathy (15%) were the leading aetiologies. No patients were SCAI A or B. Eight (10%) were SCAI C, 26 (33%) SCAI D, and 46 (58%) SCAI E. 90-day mortality increased with shock severity: 0% (C), 31% (D), and 57% (E) (log-rank p = 0.005; Figure 1). Kaplan-Meier curves showed earlier plateau in SCAI D, whereas SCAI E showed lower survival and more prolonged vulnerability. Conclusion: SCAI classification at ECMO initiation stratified 90-day mortality stepwise in this single-centre cohort and may support stage-based risk stratification in V-A ECMO-treated CS.
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Lau et al. (2026) conducted a cohort in Cardiogenic shock (n=80). SCAI classification stage vs. Lower SCAI stages was evaluated on 90-day all-cause mortality (p=0.005). Higher SCAI shock severity stages at V-A ECMO initiation were associated with increased 90-day all-cause mortality (0% for stage C, 31% for D, and 57% for E; p=0.005).
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