Abstract
Background: The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification is a validated tool for assessing cardiogenic shock (CS) severity. Dynamic changes within the first 24 hours after admission may better reflect patient trajectory and prognosis than a single baseline assessment. Methods: We prospectively enrolled 232 patients with acute myocardial infarction (AMI) admitted to the Vietnam National Heart Institute between August 2022 and April 2023. SCAI shock stage (A–E) was determined at admission and reassessed at 24 hours. The primary endpoint was long-term all-cause mortality. Results: At presentation, 50.8% of patients were in SCAI A, 21.6% in B, 23.3% in C, and 4.3% in D/E. After 24 hours, the proportion in SCAI A increased to 62.3% and C decreased to 7.7%, while 9.2% and 3.9% were in D and E, respectively. Early improvement was most frequent in stage B (27.7%) and C (25.6%), whereas deterioration occurred in 19.1% and 38.5% of these groups. Higher SCAI stage correlated with older age, lower blood pressure, elevated lactate, NT-proBNP, troponin T, impaired renal function, reduced ejection fraction, and markedly higher 30-day mortality (1.7% in stage A vs. 90% in D/E; p < 0.001). Both admission and 24-hour SCAI stage predicted long-term mortality, but the 24-hour classification provided greater prognostic discrimination. Conclusions: In AMI patients, 24-hour reassessment of SCAI shock stage offers incremental prognostic value beyond baseline classification and can identify patients at higher risk of deterioration.