Background: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). Methods: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes. Results: Pulmonary artery catheter was used in 82 (37.4%) of the 219 patients. Cardiogenic shock patients who managed with a PAC received more frequently treatment with inotropes and vasopressors, mechanical ventilation, renal replacement therapy, and mechanical assist devices ( P < .01). Overall 30-day mortality was 36.5%. Pulmonary artery catheter use did not affect mortality even after propensity score matching analysis (hazard ratio = 1.17 [0.59-2.32], P = .66). Cardiac index, cardiac power index (CPI), and stroke volume index (SVI) showed the highest areas under the curve for 30-day mortality (ranging from 0.752-0.803) and allowed for a significant net reclassification improvement of 0.467 (0.083-1.180), 0.700 (0.185-1.282), 0.683 (0.168-1.141), respectively, when added to the CardShock risk score. Conclusions: In our contemporary cohort of CS, over one-third of patients were managed with a PAC. Pulmonary artery catheter use was associated with a more aggressive treatment strategy. Nevertheless, PAC use was not associated with 30-day mortality. Cardiac index, CPI, and SVI were the strongest 30-day mortality predictors on top of the previously validated CardShock risk score.
Funding Acknowledgements
Type of funding sources: None.
Introduction
The recently proposed classification of the Society of Cardiovascular Angiography and Interventions (SCAI) stratifies cardiogenic shock (CS) in 5 stages from least to greatest severity (1,2). The aim of this project is to apply the SCAI classification to a cohort of patients in CS and analyze the results among the different stages.
Methods
Retrospective study of CS patients attended by our multidisciplinary team between September 2014-December 2020. The patients were assigned to one of the 5 stages by two independent cardiologists. SCAI subgroups were interpreted considering the recent consensus statement; based on clinical, laboratory, and hemodynamic parameters. In-hospital mortality was the main outcome analyzed.
Results
163 patients were included. Mean age was 55 years (44-62), 76% were male. 9 patients (6%) were assigned to SCAI class C, 55 (34%) D and 99 (61%) in E. There was an almost perfect concordance between the two independent cardiologists when performing the classification (kappa =0.93, p <0.001).
In-hospital mortality was 11%, 31%, and 59% in stages C, D, and E respectively (p <0.001) Figure 1. The SCAI classification had an area under the ROC curve of 0.65 to predict hospital mortality. In the multivariate analysis, SCAI stage E and initial lactate levels were independent predictors of in-hospital mortality.
Conclusion
The SCAI classification is easy to apply in clinical practice and provides a firm prediction of the prognosis of patients in CS. Each SCAI class was significantly associated with the primary endpoint. Its widespread use would allow the optimization of communication between professionals, as well as serve as the basis for the design of future research projects.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.