Does the CS-SCAI staging system predict 30-day mortality in adult cardiac surgery patients?
The adapted CS-SCAI shock staging system strongly predicts 30-day mortality and facilitates risk prognostication prior to and following cardiac surgery.
BACKGROUND: Risk prognostication is essential to identify patients at risk of higher mortality following cardiac surgery. OBJECTIVES: The Society for Cardiac Angiography and Intervention (SCAI) shock construct was adapted to cardiac surgical patients to create the CS-SCAI staging and it was applied at various time points and correlated with survival. METHODS: Retrospective analysis of Society of Thoracic Surgeons adult cardiac surgery database from January 2015 to December 2019. The focus was 30-day survival and multivariate logistic analysis was used to examine factors. CS-SCAI E indicates extracorporeal life support or biventricular devices, CS-SCAI D patients receive vasoactive(s) and a single device whereas CS-SCAI C patients have either one device or a vasoactive but not both. CS-SCAI B has heart failure, urgent surgery, or cardiopulmonary resuscitation, otherwise CS-SCAI A is assigned. RESULTS: A total of 1,164,015 patients were included. Preoperatively 35.9%, 54.9%, 8.3%, 0.7%, and 0.2% of patients were in Stages A, B, C, D, and E, respectively, with corresponding mortality of 1.2%, 2.12%, 9.84%, 17.06%, and 42.1% (chi-square P < 0.0001). In the preoperative and postoperative setting, CS-SCAI stage was the strongest predictor of mortality. Transition to worsened CS-SCAI stage postoperatively occurred in 6,508 patients with 30-day mortality 51.6%. The strongest predictors of stage transition were cardiopulmonary bypass time, preoperative CS-SCAI stage, and aortic cross clamp time. CONCLUSIONS: CS-SCAI facilitates risk prognostication prior to and following cardiac surgery. Transitions of stage are associated with a spectrum of high mortality and could be used to better define post-cardiotomy shock.
Brozzi et al. (Tue,) studied this question.