SCAI stage worsening within 24 hours of cardiogenic shock diagnosis was associated with an unadjusted mortality rate of 44.6%, compared to 34.2% for those improving.
Cohort (n=3,268)
Yes
Does serial assessment of CSWG-SCAI stages predict mortality in patients with cardiogenic shock?
Serial assessment of SCAI shock stage within the first 24 hours reveals frequent stage transitions that are strongly associated with mortality, highlighting the need for early and repeated risk stratification.
Absolute Event Rate: 44.6% vs 34.2%
BACKGROUND The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging was developed to risk stratify cardiogenic shock (CS) severity. Data showing progressive changes in SCAI stages and outcomes are limited. OBJECTIVES We investigated serial changes in CSWG-SCAI stages and outcomes of patients presenting with cardiogenic shock complicating acute myocardial infarction (MI-CS) and heart failure-related CS (HF-CS). METHODS The multicenter CSWG registry was queried. CSWG-SCAI stages were computed at CS diagnosis and 24, 48, and 72 hours. RESULTS A total of 3,268 patients (57% HF-CS; 27% MI-CS) were included. At CS diagnosis, CSWG-SCAI stage breakdown was 593 (18.1%) stage B, 528 (16.2%) stage C, 1,659 (50.8%) stage D, and 488 (14.9%) noncardiac arrest stage E. At 24 hours, >50% of stages B and C patients worsened, but 86% of stage D patients stayed at stage D. Among stage E patients, 54% improved to stage D and 36% stayed at stage E by 24 hours. Minimal SCAI stage changes occurred beyond 24 hours. SCAI stage trajectories were similar between MI-CS and HF-CS groups. Within 24 hours, unadjusted mortality rates of patients with any SCAI stage worsening or improving were 44.6% and 34.2%, respectively. Patients who presented in or progressed to stage E by 24 hours had the worst prognosis. Survivors had lower lactate than nonsurvivors. CONCLUSIONS Most patients with CS changed SCAI stages within 24 hours from CS diagnosis. Stage B patients were at high risk of worsening shock severity by 24 hours, associated with excess mortality. Early CS recognition and serial assessment may improve risk stratification.
“You can't just round in the morning and hope for the best.”
Ton et al. (2024) conducted a cohort in Cardiogenic shock complicating acute myocardial infarction and heart failure (n=3,268). SCAI stage worsening vs. SCAI stage improving was evaluated on Unadjusted mortality. SCAI stage worsening within 24 hours of cardiogenic shock diagnosis was associated with an unadjusted mortality rate of 44.6%, compared to 34.2% for those improving.