AbstractBackground/IntroductionThe Society for Cardiovascular Angiography and Intervention (SCAI) shock classification scheme risk stratifies patients with cardiogenic shock (CS). The updated SCAI shock stages removed the use of respiratory support, either non-invasive (NIV) or invasive mechanical ventilation (IMV), as a criterion. However, this decision was made with very little data on the impact of respiratory support on shock staging or outcomes.PurposeWe sought to compare the in-hospital mortality of patients with CS stratified by SCAI shock stages for patients receiving and not receiving respiratory support.MethodsWe identified adults aged ≥18 years admitted from October 1, 2015 to June 30, 2023 with a diagnosis of CS from a Clinical Data Base, which includes >1,000 hospitals across the United States. SCAI shock stages on the day of admission were calculated. We assessed for the association between respiratory support, either NIV or IMV, on the first day of admission with in-hospital mortality stratified by SCAI shock stages B through E using inverse probability treatment weighting (IPTW), adjusting for demographics, comorbidities, hospital characteristics, and vasoactive/mechanical circulatory support on admission.ResultsWe identified 506,531 patients with CS, including 4.3%, 50.2%, 34.6%, and 10.9% with SCAI stages B through E, respectively. The mean (SD) age was 65.2 (±14.9), 37.0% were women, the mean first lactate was 4.1 mmol/L, and the initial mean pH was 7.31. Respiratory support was utilized in 29.6% (n=149,708) of patients with 4.8% receiving NIV, 25.7% receiving IMV, and 0.9% receiving both on the first day of admission. The proportion of patients receiving NIV by SCAI stages were 6.1% (B), 4.6% (C), 5.2% (D), and 3.5% (E) and 6.6% (B), 6.2% (C), 37.5% (D), 85.9% (E) for patients receiving IMV. Utilization of respiratory support was associated with an increased in-hospital mortality for each SCAI shock stage (Figure 1). After IPTW adjustment, respiratory support remained associated with an increased mortality (Figure 2). Adjusted results were similar when stratified by only patients that received IMV (all, P<0.001). Amongst patients only receiving NIV, adjusted mortality was approximately 6% higher than those not receiving NIV for stages B through D (all, P<0.001), but no longer significant for stage E.Conclusion(s)Compared to patients with CS not receiving respiratory support, the use of respiratory support was associated with an increased mortality for each SCAI stage even after multivariable adjustment. Utilization of respiratory support is a simple, easily identifiable marker which requires further investigation as a CS classification modifier.Figure 1Figure 2