Findings from the Can Escalation Reduce Acute Myocardial Infarction Mortality in Cardiogenic Shock (CERAMICS) registry show that early use of small heart pumps improves outcomes in patients who experience severe heart failure, called cardiogenic shock, after having a heart attack and undergoing stenting. Researchers presented this latest data today at the Society of Cardiovascular Angiography and Interventions (SCAI) 2026 Scientific Sessions and the Canadian College of Interventional Cardiology (CAIC-ACCI) Summit.
Cardiogenic shock (CS) occurs when the heart suddenly cannot pump enough blood to the body and is the leading cause of in-hospital death after acute myocardial infarction (AMI, or heart attack). Standard approaches usually include drug therapy, early revascularization with PCI, and mechanical circulatory support devices (MCS). The CERAMICS trial was designed as part of the National Cardiogenic Shock Initiative (NCSI) to assess whether shock centers with on-site MCS escalation capabilities have better clinical outcomes.
The CERAMICS study was a single-arm, multicenter study that enrolled 124 CS patients from 20 hospitals, all of whom had the ability to escalate MCS. All patients were initially treated using a shock protocol emphasizing rapid placement of Impella™ (J&J Medtech), percutaneous coronary intervention (PCI), and invasive hemodynamic monitoring.
The study found that patients arrived at the hospital in very serious condition, with about 40% experiencing cardiac arrest. Nearly nine out of 10 patients (89%) had suffered a severe heart attack, known as an ST-elevation myocardial infarction (STEMI). On average, patients received mechanical heart support within about 76 minutes of arriving at the hospital and had their blocked arteries opened within 72 minutes (door-to-balloon time). Despite the severity of the disease, most patients (71%) survived to hospital discharge. This includes 78% of patients with SCAI stage C/D (classic/worsened) shock and 60% of patients with the most severe stage E shock (extreme).
The CERAMICS registry was the third iteration of the Shock Initiative, following the Detroit and National Cardiogenic Shock Initiatives. The National Cardiogenic Shock Initiative included 80 facilities with varying degrees of MCS escalation and ICU-level care, whereas the CERAMICS study included only facilities with MCS escalation capabilities with devices such as Impella 5.5 (J&J Medtech) and extracorporeal membrane oxygenation (ECMO). Compared to NCSI, CERAMICS patients were older, more likely to present with stage E shock, and more likely to undergo MCS escalation (22% vs 10%, p<0.01). Compared to NCSI, CERAMICS patients had similar overall survival (72% vs. 72%) but improved survival when presenting with stage E shock (67% vs. 50%, p=0.05).
Early detection and protocol-based care are central to improving survival rates for patients with shock. Most stage C and D shock patients can be successfully treated at local PCI-capable hospitals, allowing patients to receive prompt treatment close to home. However, the most critically ill patients benefit from timely transfer to centers with advanced MCS capabilities. After decades of limited progress, it is heartening to see this approach to shock care yielding real improvements for patients. ”
Babar Basir, DO, FSCAI, interventional cardiologist and medical director of the Henry Ford Health Acute MCS Program in Detroit
The researchers note that the next step in the cardiogenic shock effort is to expand to facilities around the world that are developing cardiogenic shock treatment systems.
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Society of Cardiovascular Angiography and Interventions
