Serial Shock Severity Assessment Within 72 Hours After Diagnosis: A Cardiogenic Shock Working Group Report.

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.

Informations de copyright

Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures This work was supported by institutional grants from Abiomed Inc, Boston Scientific Inc, Abbott Laboratories, Getinge Inc, and LivaNova Inc to Tufts Medical Center. The sponsors had no input on collection, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript. Dr Kanwar has served on the advisory boards for Abiomed Inc, Abbott Laboratories, and CorWave. Dr Sinha has received consulting fees from Abiomed Inc. Dr Hernandez-Montfort has received consulting fees from Abiomed Inc. Dr Garan has received consulting fees from NuPulseCV; has been on the scientific advisory board for Abiomed; and has received research support from Verantos and Abbott. Dr Hall has received consulting fees from Abiomed, Abbott, and Medtronic. Dr Vorovich has received consulting fees from and has served on the speaker bureau for advisory board and steering committee for Abiomed, Inc; has received speaker’s fees from Abbott Laboratories; and has served on the advisory board for Novo Nordisk A/S. Dr Nathan has received consulting fees from Abiomed, Getinge, and CSI. Dr Abraham has received consulting fees from Abbott Laboratories and Abiomed Inc. Dr Mahr has received consulting fees from Abbott, Abiomed, and Syncaria. Dr Burkhoff has received an unrestricted educational grant from Abiomed Inc. Dr Kapur has received consulting fees and institutional grant support from Abbott Laboratories, Abiomed Inc, Boston Scientific, Medtronic, LivaNova, Getinge, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.