Respiratory Support and Mortality Risk Across the Spectrum of Cardiogenic Shock Severity

Talal El Zarif; Cesar Caraballo; Angela M Victoria-Castro; Israel Safiriyu; Maria Gabriela Gastanadui; David M Dudzinski; Balimkiz Senman; Carlos Alviar; Guido Tavazzi; Andrea Elliott; Aniket S Rali; Mark Jacobs; Jason N Katz; Ann Gage; P Elliott Miller

doi:10.1016/j.jscai.2025.104043

Respiratory Support and Mortality Risk Across the Spectrum of Cardiogenic Shock Severity

J Soc Cardiovasc Angiogr Interv. 2025 Nov 13;4(12):104043. doi: 10.1016/j.jscai.2025.104043. eCollection 2025 Dec.

Authors

Affiliations

¹ Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
² Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut.
³ Harvard Medical School, Boston, Massachusetts.
⁴ Critical Care Cardiology Section, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
⁵ Critical Care Medicine, Duke University, Durham, North Carolina.
⁶ Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York.
⁷ Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
⁸ Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
⁹ Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
¹⁰ Department of Critical Care Medicine, Montefiore Medical Center, Bronx, New York.
¹¹ Centennial Medical Center, Nashville, Tennessee.

Abstract

Background: The Society for Cardiovascular Angiography & Intervention (SCAI) SHOCK stages classification schema risk-stratifies patients with cardiogenic shock (CS). The updated 2022 SCAI SHOCK stages removed the use of respiratory support, either noninvasive (NIV) or invasive mechanical ventilation (IMV), as a criterion. We sought to investigate the impact of receiving respiratory support on in-hospital mortality for patients with CS stratified by SCAI SHOCK stages.

Methods: Utilizing a nationally representative database, adults aged ≥18 years admitted from 2015 to 2023 with a diagnosis of CS were used to assess 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. We utilized inverse probability treatment weighting, adjusting for demographic characteristics, comorbidities, hospital characteristics, and vasoactive/mechanical circulatory support.

Results: We identified 317,325 patients with CS, including 2.4%, 39.0%, 34.2%, and 24.5% with SCAI stages B through E, respectively. Respiratory support was utilized in 38.0% (n = 120,594) of patients, with 5.4% receiving NIV, 33.8% receiving IMV, and 1.1% receiving both on the first day of admission. After inverse probability treatment weighting, respiratory support use remained associated with an increased mortality overall (weighted mean mortality increase of 18.3%; 95% CI, 17.9%-18.7%), when stratified by each SCAI SHOCK stage and in several key sensitivity analyses.

Conclusions: Compared with patients not receiving respiratory support, the use of respiratory support was associated with an increased mortality for each SCAI stage of CS and could be a simple, easily identifiable CS risk modifier.

Keywords: cardiogenic shock; critical care cardiology; invasive mechanical ventilation; noninvasive ventilation; respiratory support.