FCR-02
SCAI Shock Classification for Mortality Risk Stratification: Survey of Published Evidence
Presenter
Jacob C Jentzer, MD, Mayo Clinic Health System Rochester, Rochester, MN
Jacob C Jentzer, MD, Mayo Clinic Health System Rochester, Rochester, MN, Srihari S. Naidu, MD, FSCAI, Westchester Medical Center, New York, NY, David A. Baran, M.D., FSCAI, Cleveland Clinic Florida, Parkland, FL, Babar B Basir, DO, FSCAI, Henry Ford Health System, Detroit, MI, Deborah B Diercks, M.D., The University of Texas Southwestern Medical Center, Dallas, TX, Cindy L. Grines, M.D., MSCAI, Northside Hospital Cardiovascular Institute, Johns Creek, GA, Shelley Hall, M.D., Baylor University Medical Center, Dallas, TX, Steven M. Hollenberg, M.D., Hackensack Meridian Health, Cherry Hill, NJ, Navin K. Kapur, M.D., FSCAI, Tufts Medical Center, Boston, MA, William Kent, M.D., Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada, Sunil V. Rao, MD, FSCAI, NYU Langone Health, New York, NY, Marc Daniel Samsky, MD, Duke University Health System, Durham, NC, Alexander G. Truesdell, M.D., FSCAI, Virginia Heart / Inova Schar Heart and Vascular Institute, Mclean, VA, Sean Van Diepen, MD, MSc, University of Alberta, Edmonton, AB, Canada and Timothy D. Henry, M.D., MSCAI, The Christ Hospital Health Network, Covington, KY
Keywords: Acute Coronary Syndromes (ACS), Cardiogenic shock, Heart Failure and Hemodynamic support
Background: SCAI recently proposed a classification characterizing cardiogenic shock severity. We sought to determine if the SCAI shock stages could provide mortality risk stratification.
Methods: As part of a SCAI-sponsored consensus update to the SCAI shock classification, PubMed was reviewed for studies examining clinical outcomes as a function of SCAI shock stage in any population.
Results: We identified 14 manuscripts reporting more than 15,000 unique patients including cardiogenic shock, cardiac arrest (CA) and cardiac intensive care unit cohorts; 1 study was prospective, and none were clinical trials. Studies examined 7 separate definitions of the SCAI shock stages, yielding a prevalence of each SCAI shock stage as follows: A, 0-46%; B, 0-41%; C, 13-61%; D, 7-55%; E, 1-31%. Each study demonstrated a stepwise increase in short-term (in-hospital or 30-day) mortality with each higher SCAI shock stage (Figure); this was consistent in all tested subgroups. Mortality at each SCAI shock stage varied according to study population and definition: A, 1-5%; B, 0-34%; C, 11-54%; D, 24-68%; E, 42-77%. Risk modifiers that further increased mortality risk at each SCAI shock stage included the presence of CA, systemic inflammation, poor hemodynamics, worsening shock and older age.
Conclusions: The SCAI shock stages paradigm is effective for mortality risk stratification in different cohorts across a variety of care settings. Observed mortality is greater at each higher shock stage and varies substantially according to the study definition, population, and concomitant risk factors. These data should inform further modifications of the SCAI shock classification.
