Higher SCAI cardiogenic shock stages were associated with increased hospital mortality compared with stage A (adjusted OR 1.53 to 6.80; p<0.001).
Cohort (n=10,004)
No
Does the SCAI cardiogenic shock classification predict hospital mortality in a cardiac intensive care unit population?
The SCAI cardiogenic shock classification, assessed at CICU admission, provides robust risk stratification for hospital mortality.
Effect estimate: adjusted OR 1.53 to 6.80
p-value: p=<0.001
BACKGROUND A new 5-stage cardiogenic shock (CS) classification scheme was recently proposed by the Society for Cardiovascular Angiography and Intervention (SCAI) for the purpose of risk stratification. OBJECTIVES This study sought to apply the SCAI shock classification in a cardiac intensive care unit (CICU) population. METHODS The study retrospectively analyzed Mayo Clinic CICU patients admitted between 2007 and 2015. SCAI CS stages A through E were classified retrospectively using CICU admission data based on the presence of hypotension or tachycardia, hypoperfusion, deterioration, and refractory shock. Hospital mortality in each SCAI shock stage was stratified by cardiac arrest (CA). RESULTS Among the 10,004 unique patients, 43.1% had acute coronary syndrome, 46.1% had heart failure, and 12.1% had CA. The proportion of patients in SCAI CS stages A through E was 46.0%, 30.0%, 15.7%, 7.3%, and 1.0% and unadjusted hospital mortality in these stages was 3.0%, 7.1%, 12.4%, 40.4%, and 67.0% (p < 0.001), respectively. After multivariable adjustment, each higher SCAI shock stage was associated with increased hospital mortality (adjusted odds ratio: 1.53 to 6.80; all p < 0.001) compared with SCAI shock stage A, as was CA (adjusted odds ratio: 3.99; 95% confidence interval: 3.27 to 4.86; p < 0.001). Results were consistent in the subset of patients with acute coronary syndrome or heart failure. CONCLUSIONS When assessed at the time of CICU admission, the SCAI CS classification, including presence or absence of CA, provided robust hospital mortality risk stratification. This classification system could be implemented as a clinical and research tool to identify, communicate, and predict the risk of death in patients with, and at risk for, CS.
“Essentially, when we first took a stab at this, I think it really caught like wildfire because there was nothing out there. There was nothing that would allow people to even communicate. And so people were happy with just having a lexicon itself.”
Jentzer et al. (2019) conducted a cohort in Cardiac intensive care unit patients (n=10,004). SCAI cardiogenic shock classification vs. SCAI shock stage A was evaluated on Hospital mortality (adjusted OR 1.53 to 6.80, p=<0.001). Higher SCAI cardiogenic shock stages were associated with increased hospital mortality compared with stage A (adjusted OR 1.53 to 6.80; p<0.001).