SCAI cardiogenic shock classification after out of hospital cardiac arrest and association with outcome

Abstract

Objectives We aimed to validate the Society for Cardiovascular Angiography and Interventions (SCAI) classification to evaluate association with outcome in a real‐world population and effect of invasive therapies. Background Cardiogenic shock is common after Out of Hospital Cardiac Arrest (OOHCA) but is often multifactorial and challenging to stratify. Methods The SCAI shock grade was applied to an observational registry of OOHCA patients on admission to our center between 2012 and 2017. The primary end‐point was 30‐day mortality and secondary end‐points were mode of death and 12‐month mortality. Provision of early CAG and mechanical circulatory support (MCS) was evaluated by SCAI shock grade using logistic regression. Results Three hundred and ninety‐three patients (median age 64.3 years (24.9% females) were included. One hundred and seven patients (27.2%) were in Grade A, 94 (23.9%) in Grade B, 66 (16.8%) in Grade C, 91 (23.2%) in Grade D, and 35 (8.9%) in Grade E. There was a step‐wise significant increase in 30‐day mortality with increasing shock grade (A 28.9% vs. B 33.0% vs. C 54.5% vs. D 59.3% vs. E 82.9%; p < .0001). With worsening shock grade, requirement for renal replacement therapy and mortality from multiorgan dysfunction syndrome and cardiogenic causes increased. Early CAG was performed equally in all groups but was significantly associated with reduced mortality in SCAI grade D only (OR 0.26 [CI 0.08–0.91], p = .036). Conclusions Increasing SCAI shock grade after OOHCA is associated with 30‐day mortality, requirement for renal replacement therapy and mortality attributed to multiorgan dysfunction syndrome and cardiac etiology death.

Prospective validation of the SCAI shock classification: Single center analysis

“…Schrage and colleagues have also validated the SCAI stage to predict 30‐day mortality in more than 1,000 consecutive patients presenting with CS or large acute myocardial infarction 18 . Pareek and colleagues applied the classification to 393 out‐of‐hospital cardiac arrest cases as well, showing similar predictive value of the SCAI Shock Stage 19 …”

Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome

“…In a large study of unselected CS patients (n = 1004), SCAI classification system was independently associated with the 30-day survival as well [70]. The classification was also validated in the setting of out-of-hospital cardiac arrest [71].…”

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.…”

“…Moreover, they found that the reassessment of SCAI stage at 24 hours has refined the prognosis. The SCAI shock classification has also been validated retrospectively in specific subsets of patients i.e., after out of hospital cardiac arrest (n = 393) [111] and AMI (n = 300). [112] Additionally, from an analysis of a nationwide registry, Thayer and colleagues have validated the SCAI classification in the prediction of in-hospital mortality in patients presenting with CS (n = 1,414).…”