SCAI Releases Updated Expert Consensus to SCAI SHOCK Classification

The Society for Cardiovascular Angiography and Interventions (SCAI) on Jan. 31 released an expert consensus statement updating the SCAI SHOCK classification. The document was simultaneously published in the Journal of the Society for Cardiovascular Angiography & Interventions and the Journal of the American College of Cardiology, and was endorsed by the ACC, American College of Emergency Physicians, American Heart Association, European Society of Cardiology, Association for Acute Cardiovascular Care, Society of Critical Care Medicine, International Society for Heart and Lung Transplantation and Society of Thoracic Surgeons.

The document updates the 2019 SCAI SHOCK classification. The 2019 system has been widely adopted, but newer validation studies conducted since 2019 have provided new detailed information. The writing group, led by Srihari S. Naidu, MD, FACC, reviewed and synthesized validation studies of the original classification to identify potential areas of refinement. The new update clarifies the role of the SCAI SHOCK classification within a comprehensive 3-axis model incorporating other predictors of mortality, such as etiology and phenotype and nonmodifiable risk factors like age and frailty. In addition, the update provides more granularity to the cardiac arrest modifier and the constituent domains of the classification, including physical examination, biochemical and hemodynamic criteria.

SCAI and the endorsing societies anticipate the classification to continue to evolve and “be refined as high-quality data accumulate.”

“Our hope is that the revised criteria will allow for more uniform classification to help clinicians choose patients for advanced therapies, but also to define criteria for entry into clinical trials to better understand the value of potential therapies,” Naidu, et al., write. “A crucial next step in this field will be to compare the outcomes associated with drug and device therapies, systems of care and treatment protocols for patients at different Stages or trajectories, phenotypes, and modifiers of shock,” they add.

“The new updated definition is easier to use, with tables that have eliminated relatively unnecessary variables and highlighted the more commonly present ones in each shock stage, a more useful cardiac arrest modifier, and a 3-axis model that places the shock stages in context of other variables that need to be considered for the patient in front of you,” Naidu said. “Further, we have made it much clearer how patients move up and down the stages if they deteriorate or recover, what these changes do to survival, and how support strategies such as mechanical support devices or vasopressors tie into the various stages."

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Pharmaceutical Preparations, Surgeons, Phenotype, Hemodynamics, Clinical Protocols, Physical Examination, Lung Transplantation, Angiography, Heart Arrest, Critical Care, Risk Factors, Cardiology, Frailty, American Heart Association, Shock, Cardiogenic

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