Findings from the Can Escalation Reduce Acute Myocardial Infarction Mortality in Cardiogenic Shock (CERAMICS) registry demonstrate that early use of a small heart pump improves outcomes in patients experiencing a severe form of heart failure called cardiogenic shock after suffering from a heart attack and undergoing a stenting procedure. Researchers presented this late-breaking data today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions & Canadian Association of Interventional Cardiology (CAIC-ACCI) Summit.
Cardiogenic shock (CS) happens when the heart suddenly cannot pump enough blood to the body and is a leading cause of in-hospital mortality following an acute myocardial infarction (AMI, or a heart attack). Standard approaches typically include medications, early revascularization with PCI, and mechanical circulatory support devices (MCS). The CERAMICS trial, as a part of the National Cardiogenic Shock Initiative (NCSI), was designed to evaluate whether clinical outcomes were better in shock centers that have the capability of on-site MCS escalation.
The CERAMICS study is a single-arm, multi-center study that enrolled 124 patients with CS across 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 monitoring of hemodynamics.
The study found that patients arrived at the hospital in extremely critical condition, with about 40% experiencing cardiac arrest. Nearly nine in ten patients (89%) were having a severe type of heart attack known as 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 artery opened within 72 minutes (door-to-balloon time). Despite the severity of illness, most patients (71%) survived hospital discharge, including 78% of those in the SCAI stage C/D (classic/deteriorating) shock and 60% of those in the most severe stage E shock (Extremis).
The CERAMICS registry was the third iteration of the shock initiative, after the Detroit and National Cardiogenic Shock Initiatives. Whereas the National Cardiogenic Shock Initiative included 80 sites with varying degrees of MCS escalation and ICU-level care, the CERAMICS study included only sites with MCS escalation capabilities with devices like Impella 5.5 (J&J Medtech) and extracorporeal membrane oxygenation (ECMO). When compared to NCSI, patients in CERAMICS were older, more likely to present in Stage E Shock, and were more likely to undergo MCS-escalation (22% vs 10%, p<0.01). When compared to NCSI, patients in CERAMICS had similar overall survival (72% vs 72%) but had improved survival when presenting in Stage E shock (67% vs 50%, p=0.05).
Early recognition and protocol-driven care are central to improving survival in patients with shock. Most stage C and D shock patients can be successfully treated at local PCI-capable hospitals, ensuring patients get care quickly, close to home. However, the sickest patients benefit from timely transfer to centers with advanced MCS capabilities. After decades of limited progress, it's encouraging to see this shock-care approach delivering real improvements for patients."
Babar Basir, DO, FSCAI, interventional cardiologist and medical director of the acute MCS program, Henry Ford Health, Detroit
Researchers note that the next phase of the cardiogenic shock initiative is to expand to global sites that are looking to create cardiogenic shock systems of care.
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