SCAI shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative

Abstract

Objectives: We applied the cardiovascular angiography and interventions (SCAI) shock staging system to patients presenting with acute myocardial infarction and cardiogenic shock (AMI-CS) who were enrolled in the National Cardiogenic Shock Initiative (NCSI). Background: The SCAI shock staging system provides a framework for evaluation of patients with CS based on clinical and hemodynamic parameters, but has not been validated in patients with AMI-CS managed with a contemporary treatment algorithm that incorporates early use of Impella. Methods: Consecutive patients enrolled in NCSI were identified, all of whom were managed with invasive hemodynamic guidance and supported with Impella. Patients were retrospectively categorized into appropriate SCAI shock stages, and outcomes were assessed accordingly. Results: A total of 300 patients were included in the analysis; 182 patients (61%) presented in Stage C shock, 25 (8%) in Stage D, and 93 (31%) in Stage E. Survival to hospital discharge was 76, 76, and 58%, respectively (p = .006). Survival was <20% among patients in Stage E at 24 hr, regardless of baseline stage. There was near perfect agreement in shock staging between two independent clinicians at baseline (kappa = 0.975, 95% CI, 0.95-1.00, p < .001) and at 24 hr (kappa = 0.985, 95% CI, 0.77-1.00, p < .001). Conclusion: In patients with AMI-CS enrolled in NCSI, SCAI Shock classification was reproducible, and predicted survival when applied at presentation and at 24 hr.

The year in cardiovascular medicine 2020: heart failure and cardiomyopathies

“…While its incidence seems to be decreasing, cardiogenic shock still conveys a high mortality risk. 69 A new clinical classification, 70 and two position papers 71,72 on cardiogenic shock have been published this year. The SWEdish evaluation of left Ventricular Assist Device (SweVAD) will examine the impact of mechanical circulatory support vs. guidelinedirected medical therapy on survival in a population of AHF patients ineligible for heart transplant.…”

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.…”

“…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). They have also demonstrated the association of both escalated SCAI stages and in-hospital mortality with worsening venous congestion.…”

It's not shocking that the SCAI shock classification works

“…Perhaps the sickest patients were excluded from randomization, because based on the German registry, 3 In this issue of the journal, Hanson et al reported their findings in 300 patients enrolled in the multicenter (NCSI). 5 Since this prospective study required all patients to be hypotensive with end-organ hypoperfusion severe enough to be treated with impella, the SCAI classification was largely confined to C-E. The population consisted of 80% STEMI, and the protocol called for placement of impella prior to primary PCI.…”

“…In this issue of the journal, Hanson et al reported their findings in 300 patients enrolled in the multicenter (NCSI) 5 . Since this prospective study required all patients to be hypotensive with end‐organ hypoperfusion severe enough to be treated with impella, the SCAI classification was largely confined to C–E.…”