Mixed venous oxygen saturation identifies high-risk physiology in advanced cardiogenic shock
DOI:
https://doi.org/10.62838/jccm-2026-0034Keywords:
Cardiogenic Shock, Hemodynamics, Mixed venous oxygen saturation, SCAI shock classification, Acute myocardial infarctionAbstract
Background
Early risk stratification of patients with cardiogenic shock due to acute myocardial infarction remains challenging. Although SCAI staging has been widely adopted, this system is primarily based on clinical presentation and does not fully assess early physiological hemodynamic derangements1. Hemodynamic parameters and indices related to oxygen transport and utilization may help assess short-term mortality risk among patients with cardiogenic shock within the same SCAI stage.
Objectives
To evaluate the role of mixed venous oxygen saturation (SvO₂) and hemodynamic parameters in combination with SCAI staging, stratifying 30-day mortality risk in patients with cardiogenic shock due to acute myocardial infarction.
Methods
This study presents an analysis of baseline data from 84 patients with cardiogenic shock due to acute myocardial infarction, selected from a larger study registered on ClinicalTrials.gov (NCT07062744). Hemodynamic parameters and indices of oxygen delivery–consumption were collected immediately after insertion of the pulmonary artery catheter (T0). The SCAI stage was determined at the same time point. The primary outcome was all-cause mortality within 30 days. This baseline analysis was prespecified in the registered protocol before outcome assessment.
Results
Thirty-day mortality in the overall study population was 32.1% (27/84). Baseline SvO₂ demonstrated the strongest ability to discriminate 30-day mortality risk (AUC 0.699; p=0.003). Mortality was higher in patients with SvO₂ <53% compared with those with SvO₂ ≥53% (54.8% vs 18.9%; p=0.0014). Within the same SCAI stage, SvO₂ enabled mortality risk classification using a threshold of 53%. The group with the highest mortality was SCAI stage E with SvO₂ <53%.
Conclusions
Mixed venous oxygen saturation (SvO₂) with a threshold of 53% enables stratification of 30-day mortality risk in patients with cardiogenic shock within the same SCAI stage.
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Copyright (c) 2026 Thang Pham Xuan, Minh Nguyen Duy, Hoi Dang Van, Dat Nguyen Tien, Thu Nguyen, Hung Ha Tran, Quan Nguyen Huu, Tuan Nguyen Anh (Author)
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