SCAI stage reclassification at 24 h predicts outcome of cardiogenic shock: Insights from the Altshock‐2 registry

Morici, Nuccia; Frea, Simone; Bertaina, Maurizio; Sacco, Alice; Corrada, Elena; Dini, Carlotta Sorini; Briani, Martina; Tedeschi, M; Saia, Francesco; Colombo, Costanza Natalia Julia; Rota, Matteo; Oliva, Fabrizio; Iannaccone, Mario; Ferrari, Gaetano Maria De; Sionís, Alessandro; Kapur, Navin K.; Tavazzi, Guido; Pappalardo, Federico

doi:10.1002/ccd.30484

Cited by 27 publications

(29 citation statements)

References 16 publications

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“…[22] On the other hand, data from the Altshock-2 Registry with 237 patients hospitalized with CS between 2020 and 2022 showed that the deteriorating rates in SCAI stages after 24 hours were 41%, 6.7%, 11.3% in patients were initially classified as stages B, C, and D, respectively. [23] Differences in the focused populations between our study and other studies prevent any direct comparison of the distribution and progression of SCAI shock stages. However, findings from our study suggest that most AMI patients presented to the hospital with either stable but at-risk conditions (SCAI stage A) or early shock stage (SCAI stage B), and these patients tended to remain stable in the next 24 hours.…”

Section: Scai Stages Distribution and Transitionmentioning

confidence: 82%

“…Several recent studies have shown that changes in the SCAI stage after 24 hours of access may also provide valuable prognostic information. [21][22][23] The present study aimed to describe the distribution at admission and transition of the SCAI stages and after 24 hours and their association with 30-day mortality in patients with AMI in a major referral center in Vietnam.…”

Section: Introductionmentioning

confidence: 99%

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Distribution and 24-hour transition of SCAI shock stages and their association with 30-day mortality in acute myocardial infarction

Pham,

Van,

Hoang

et al. 2023

Medicine

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The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification has been shown to predict mortality in acute myocardial infarction (AMI). However, data on the transition of SCAI stages and their association with mortality after AMI are limited. All patients with AMI admitted to Vietnam National Heart Institute between August 2022 and February 2023 were classified into SCAI stages A, B, and C/D/E at admission and were reevaluated in 24 hours. We used Kaplan–Meier estimate and multivariable Cox regression analysis to assess the association between SCAI stages transition and 30-day mortality. We included 139 patients (median age 69 years, 29.5% female). On admission, 50.4%, 20.1%, and 29.5% of patients were classified as SCAI stage A, B, and C/D/E, respectively. The proportion of patients whose SCAI stage improved, remained stable, or worsened after 24 hours was 14.4%, 66.2%, and 19.4%, respectively. The 30-day mortality in patients with initial SCAI stages A, B, and C/D/E on admission was 2.9%, 21.4%, and 61.0%, respectively (P < .001). The 30-day mortality was 2.4% for patients with baseline SCAI stage A/B who remained unchanged or improved, 30.0% for patients with baseline SCAI stage C/D/E who remained unchanged or improved, and 92.6% for patients with SCAI stage B/C/D/E who worsened at 24 hours after admission (log-rank P < .001). In patients with AMI, evaluating the SCAI stage shock stage on admission and reevaluating after 24 hours added more information about 30-day mortality.

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Section: Scai Stages Distribution and Transitionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Distribution and 24-hour transition of SCAI shock stages and their association with 30-day mortality in acute myocardial infarction

Pham,

Van,

Hoang

et al. 2023

Medicine

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show abstract

“…However, most published studies examining the association between the SCAI Shock classification and mortality have assessed shock severity at a single time point, often including data from different periods during hospitalization (14)(15)(16)(17). Those few studies that have recorded the SCAI Shock classification more than once have typically assessed shock severity at admission followed by a repeat assessment at 24 h or determined the worst stage during hospitalization (18)(19)(20)27,28). These studies have generally observed that persistently high or increasing shock severity is associated with a worse outcome than decreasing shock severity.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Performance of Serial Determination of the Society for Cardiovascular Angiography and Interventions Shock Classification in Adults With Critical Illness

Jentzer,

Sanghavi,

Patel

et al. 2023

Shock

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Purpose To evaluate whether serial assessment of shock severity can improve prognostication in intensive care unit (ICU) patients. Materials and Methods Retrospective cohort of 21,461 ICU patient admissions from 2014 to 2018. We assigned the Society for Cardiovascular Angiography and Interventions (SCAI) Shock Stage in each 4-hour block during the first 24 hours of ICU admission; shock was defined as SCAI Shock Stage C, D, or E. In-hospital mortality was evaluated using logistic regression. Results The admission SCAI Shock Stage was: A, 39.0%; B, 27.0%; C, 28.9%; D, 2.6%; E, 2.5%. SCAI Shock Stage subsequently increased in 30.6%, and late-onset shock developed in 30.4%. In-hospital mortality was higher in patients who had shock on admission (11.9%) or late-onset shock (7.3%) versus no shock (4.3%). Persistence of shock predicted higher mortality (adjusted OR 1.09 [95% CI 1.06-1.13] for each ICU block with shock). The mean SCAI Shock Stage had higher discrimination for in-hospital mortality than the admission or maximum SCAI Shock Stage. Dynamic modeling of the SCAI Shock Classification improved discrimination for in-hospital mortality (C-statistic 0.64 to 0.71). Conclusions Serial application of the SCAI shock classification provides improved mortality risk stratification compared to a single assessment on admission, facilitating dynamic prognostication.

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“…Morici et al 3 in a recent original article reported in hospital mortality rates based on SCAI stage. They found a statistically significant higher rate of mortality in those with SCAI stage D and E at enrollment.…”

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confidence: 99%