Table 4. SCAI CS classification.
BD: base deficit; BNP: B-type natriuretic peptide; CI: cardiac index; CVP: central venous pressure; GFR: glomerular filtration rate; HF: heart failure; HR: heart rate; JVP: jugular venous pressure; MAP: mean arterial pressure; MI: myocardial infarction; PA: pulmonary artery; PCWP: pulmonary capillary wedge pressure; SCAI: Society for Cardiovascular Angiography and Interventions; SAP: systolic arterial pressure; CS: cardiogenic shock
| Stage | Presentation | Signs and symptoms | Biochemical indices | Hemodynamics |
| A (at risk) | No symptoms, history of MI or HF | Normal peripheral pulse, JVP, alertness, pulmonary auscultation | Normal serum lactates, renal function, and remaining blood test values | SAP>100 mmHg or baseline, CI>2.5 L/min/m2, CVP≤10 mmHg, PCWP≤15 mmHg, PA saturation≥65% |
| B (beginning) | Hemodynamic instability without hypoperfusion | Elevated JVP, normal peripheral pulse and alertness, fine crackles | Normal serum lactates, elevated BNP, first-degree renal decompensation | SAP<90 mmHg, MAP<60 mmHg or fall>30 mmHg from baseline, HR>100 bpm, normal remaining parameters |
| C (classic) | Hypotension, fatigue | Altered mental status, cold and clammy skin, coarse crackles, >2s capillary refill time, urine output<30 mL/h | Serum creatinine>1.5× baseline or >0.3 mg/dL or GFR<50%, lactates>2 mmol/L, elevated BNP | CΙ<2.2 L/min/m2, PCWP>15 mmHg |
| D (decline) | Declining, failed treatment | As in stage C but declining | As in stage C but declining | Dose increase or vasopressor addition or mechanical support |
| E (extremis) | Collapse/ongoing cardiopulmonary resuscitation | Loss of consciousness, cardiac collapse, multiple defibrillations | Lactates≥8 mmol/L, pH<7.2, BD>10 mEq/L | Persistent hypotension despite maximum support, vasopressors bolus intravenously |