CERAMICS Trial Shows 71 Percent Survival with Early MCS and Escalation in AMI Cardiogenic Shock
USA: Cardiogenic shock complicating acute myocardial infarction (AMI-CS) continues to carry a high risk of death, but a new study suggests that early, protocol-driven use of mechanical circulatory support (MCS) with the ability to escalate therapy may significantly improve survival.
Findings from the Can Escalation Reduce Acute Myocardial Infarction Mortality in Cardiogenic Shock (CERAMICS) registry were presented at the SCAI Scientific Sessions 2026 by Mir Babar Basir, DO, of Henry Ford Health in Detroit, and colleagues. It highlights the potential benefits of a structured treatment strategy in specialized shock centers. The study evaluated whether rapid deployment of MCS devices, combined with invasive hemodynamic monitoring and a predefined escalation pathway, could improve outcomes in patients with AMI-related cardiogenic shock.
Cardiogenic shock occurs when the heart suddenly fails to pump sufficient blood, often following a heart attack, and remains a leading cause of in-hospital mortality despite advances in revascularization and critical care. Traditional management includes medications, percutaneous coronary intervention (PCI), and supportive devices. However, mortality rates have historically remained between 30% and 50%, underscoring the need for improved strategies.
The CERAMICS study, part of the broader National Cardiogenic Shock Initiative, was a prospective, multicenter, single-arm investigation conducted across 20 hospitals equipped with advanced MCS escalation capabilities. A total of 124 patients with cardiogenic shock were enrolled. All participants were managed using a standardized protocol that prioritized early insertion of the Impella heart pump, timely PCI, and continuous hemodynamic assessment using pulmonary artery catheters.
Key Findings:
- The cohort was critically ill, with around 40% experiencing cardiac arrest and nearly 89% presenting with ST-elevation myocardial infarction (STEMI).
- Rapid treatment was achieved, with a median of 76 minutes to initiate mechanical circulatory support and 72 minutes for reperfusion via PCI.
- Overall survival to hospital discharge was 71%, indicating improved outcomes in this high-risk group.
- Survival was higher in SCAI stage C/D shock (78%) and remained notable even in stage E shock (60%), which is typically associated with very poor prognosis.
- Nearly two-thirds of patients received mechanical circulatory support prior to PCI, and most underwent invasive hemodynamic monitoring.
- About 23% of patients required escalation to advanced support such as Impella 5.5 or ECMO, with encouraging survival outcomes in this subgroup.
- Complications were common, with approximately 47% requiring blood transfusions, 52% developing acute kidney injury, and 21% needing dialysis.
- Compared to earlier phases of the shock initiative, CERAMICS showed similar overall survival despite involving older and more severely ill patients, with improved outcomes in those with the most severe shock.
The investigators concluded that early identification of cardiogenic shock and prompt initiation of guideline-based therapies, including mechanical support and invasive monitoring, are essential. They emphasized that treatment in centers capable of escalating support may further enhance survival.
Future efforts will focus on expanding this model globally to establish standardized systems of care for cardiogenic shock to improve outcomes across diverse healthcare settings.
Reference:
Basir MB "Can escalation reduce AMI mortality in cardiogenic shock (CERAMICS study)" SCAI 2026.
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