Introduction: Cardiogenic shock is a life threatening condition with high in-hospital mortality requiring rapid assessment and management. A five-stage classification system to stratify Cardiogenic Shock severity has been proposed by the Society for Cardiovascular Angiography and Interventions. This systematic review estimates the use of SCAI staging to determine the prognosis in various etiologies of Cardiogenic shock.
Methods: Pubmed, Embase and Cochrane library data bases were used to perform a systematic search of studies published between Jan, 2019 and July, 2025. “SCAI classification”, “SCAI prognosis” and “Cardiogenic shock staging” were the widely used search terms. Studies that included were adults with Cardiogenic shock stratified by SCAI staging, mortality outcomes based on SCAI staging. Newcastle Ottawa Scale was used to assess the risk of bias.
Results: Inclusion criteria: Twelve studies involving 9,238 patients . Higher SCAI stages aligned with higher 30-day and in-hospital mortality across populations. Mortality ranged from 23% (Stage C) to 67% (Stage E) in acute myocardial infarction related cardiogenic shock. Predictive accuracy was increased through dynamic reassessment of the stage at 24 hours. High inter-rater reliability was shown by SCAI staging, which also made it easier to make a decision of the utilization of mechanical circulatory support and activate the shock team early.
Conclusions: SCAI staging can be used as a reliable, validated tool to determine the prognosis of cardiogenic shock. It would be ideal to adopt and integrate the tool to identify early risk stratification and to direct management based on different stages.
