Key result
SCAI classification at 6 hours strongly predicts 30-day and 1-year mortality and circulatory support use.
Why the study?
When applied retrospectively for research, SCAI classification poses challenges with frequent missing information or omission of data timing, prompting evaluation of its timing and correlation with mortality.
Does SCAI classification assessed at 6 hours post-admission improve mortality prediction compared to assessment at admission in patients with cardiogenic shock?
Does SCAI classification assessed at 6 hours post-admission improve mortality prediction compared to assessment at admission in patients with cardiogenic shock?
Assessing SCAI shock stage up to six hours after admission, rather than strictly at admission, significantly improves the prediction of mechanical circulatory support use and mortality in cardiogenic shock patients.
SCAI staging at 6 hours was associated with mortality and support use in cardiogenic shock; extends prior staging but leaves open prospective validation.
Background The Society for Cardiovascular Angiography and Interventions (SCAI) classification is a system used to categorize the severity of cardiogenic shock (CS), based on clinical parameters, namely patient's hemodynamic status and the degree of organ dysfunction. When applied retrospectively for research purposes, SCAI classification poses challenges, with frequent missing information or omission of the real timing of the data registered. Purpose The aim of the study was to define SCAI classification at two different times and to compare its correlation with mortality. Methods Retrospective data of 175 CS patients admitted to an intensive cardiac unit between 2018 and 2022 was analyzed. Comorbidities, diagnosis, left ventricular ejection fraction (LVEF) and analytic data at presentation were registered. SCAI classification based on information at admission (SCAI 0) and with data up to six hours after admission (SCAI 6) was done. Critical care support used and mortality outcomes at 30 days and 1 year were registered. Chi-square test was used to test the association between SCAI classification and mechanical circulatory support used and between SCAI classification and mortality at 30 days and 1-year. Logistic regression was used to predict mortality. Results At SCAI 0, 38 patients (21.7%) were classified as stage A, 36 (20.6%) at stage B, 54 (30.9%) at stage C, 7 (4.0%) at stage D and 40 (22.9%) at stage E. Based on SCAI 6, 14 patients (8.0%) were on a stage A, 28 (16.0%) at stage B, 65 (37.1%) at stage C, 41 (23.4%) at stage D and 27 (15.4%) at stage E. There was a statistically significant difference between the distribution of SCAI classification at SCAI 0 and SCAI 6 (p < 0.001), exposed in Graph 1. Unlike SCAI 0 (p = 0.696), SCAI 6 correlated with mechanical circulatory support use (R² = 0.198, p < 0.001). SCAI 0 did not correlate with mortality at 30 days (p = 0.938) nor 1-year (p = 0.863). SCAI 6 was associated with mortality at 30 days (R² = 0.135, p < 0.001) and with mortality at 1-year (R² = 0.129, p = 0.002). Conclusion SCAI classification based on data from admission and evolution during the first six hours provided a more accurate assessment, as only using data up to six hours after admission was correlated with critical care support used and mortality. This study may suggest that a more dynamic time-sensitive approach whit the assignment of the SCAI shock stage done later after admission may help better classify, support and predict mortality in patients with cardiogenic shock.
No takes yet. Share an insight, caveat, or question.
Almeida et al. (2025) studied this question. SCAI classification based on data within 6 hours after admission strongly predicted 30-day (p<0.001) and 1-year mortality (p=0.002) and correlated with circulatory support use.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: