Prospective validation of the SCAI shock classification: Single center analysis

Abstract

Background: The Society for Cardiac Angiography and Interventions (SCAI) Shock Classification has been retrospectively validated by several groups. We sought to prospectively study outcomes of consecutive patients with reference to initial SCAI Shock Stage and therapeutic strategy as well as 24 hr SCAI Shock Stage reassessment. Methods: Kaplan Meier method was used to describe survival and Cox Proportional hazards modeling used to assess predictors of survival. Results: Over an 18-month period, 166 patients were referred for evaluation. Demographics, hemodynamics, and most laboratory findings were similar between SCAI stages, which were assigned by the team. Initial SCAI Stage was a strong predictor of survival. Thirty-day survival was 100, 65.4, 44.2, and 60% for patients with initial SCAI shock stage B, C, D, and E respectively (p = .0004). Age and initial SCAI Shock Stage were shown to be the strongest predictors of survival by Cox proportional hazards. Mode of mechanical circulatory support (MCS) or lack of such was not a predictor of outcome. Shock stage at 24 hr was also examined. Thirty-day survival was 100, 96.7, 66.9, 21.6, and 6.2% for patients with 3-4 SCAI stage improvement, 2 stage improvement, 1 stage improvement, no change in SCAI stage and worsening of SCAI stage respectively (p < .0001). Conclusions: Initial SCAI Shock stage predicts the survival of unselected patients with a variety of MCS interventions and medical therapy alone. The 24-hr reassessment of shock stage further refines the prognosis.

Towards a standardized classification of cardiogenic shock: Will the new SCAI staging system translate into better clinical practice and research?

“…Despite a relatively small sample size, this study by Baran et al 3 supports the validity of the latest SCAI classification in clinical practice and research studies. The strong correlation between shock stage and short‐term mortality risk allows clinicians to balance each intervention's risks and benefits, especially invasive ones.…”

“…In this issue of the Journal, Baran et al 3 applied the SCAI CS staging system to a cohort of 166 patients admitted to Sentara Heart Hospital and showed its ability to identify patients with elevated mortality risk. The investigators prospectively assigned a SCAI stage to each patient based on an agreement between the different multidisciplinary cardiogenic shock team members and using an algorithm that incorporates various clinical and laboratory parameters.…”

A Critical Review of Hemodynamically Guided Therapy for Cardiogenic Shock: Old Habits Die Hard

“…The new schema emphasizes that shock is a progressive state. There is inherent emphasis made on time to recognition, time to evaluation, and ultimately time to perfusion, whether that is with pharmacologic or MCS, to prevent the progression from Stage A to Stage E. This classification scheme has been applied in different studies, both retrospective and prospective, to accurately stratify the risk of in-hospital mortality [14,15]. In the retrospective Mayo Clinic study, each progressive SCAI shock stage was associated with increased hospital mortality irrespective of cause of cardiogenic shock.…”

Vasoactive pharmacologic therapy in cardiogenic shock: a critical review

“…[106] Several studies have validated the SCAI classification in the acute settings. [106][107][108][109][110][111][112] Jentzer et al [107] retrospectively investigated the construct validity of the SCAI classification at the time of cardiac intensive care unit admission and found a robust association between the SCAI CS stages and hospital mortality in heterogenous critically ill patients (n = 10,004). Upon further analysis of the hospital survivors (n = 9,096), [108] the aforementioned group demonstrated that the SCAI classification at admission predicted the post-discharge mortality as well.…”

“…Similarly, Schrage et al [109] reported independent association of the SCAI classification and the 30-day mortality in patients presented with CS or large AMI (n = 1,004). Baran et al [110] were the first to prospectively show that initial SCAI stage was predictive for survival in unselected critically ill patients (n = 166). Moreover, they found that the reassessment of SCAI stage at 24 hours has refined the prognosis.…”