SCAI stage reclassification at 24 h predicts outcome of cardiogenic shock : Insights from the Altshock-2 registry
Morici, Nuccia (IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS)
Frea, Simone (Città della Salute e della Scienza di Torino)
Bertaina, Maurizio (ASL Città di Torino)
Sacco, Alice (ASST Grande Ospedale Metropolitano Niguarda)
Corrada, Elena (Humanitas Research Hospital IRCCS Rozzano)
Dini, Carlotta Sorini (University of Siena)
Briani, Martina (Humanitas Research Hospital IRCCS Rozzano)
Tedeschi, Michele (S. Giovanni Di Dio e Ruggi D'Aragona Hospital)
Saia, Francesco (Policlinico S. Orsola-Malpighi)
Colombo, Costanza (Fondazione Policlinico San Matteo Hospital IRCCS)
Rota, Matteo (University of Brescia)
Oliva, Fabrizio (ASST Grande Ospedale Metropolitano Niguarda)
Iannaccone, Mario (ASL Città di Torino)
De Ferrari, Gaetano M. (University of Torino)
Sionis, Alessandro (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Kapur, Navin K. (Tufts Medical Center)
Tavazzi, Guido (Anestesia e Rianimazione I)
Pappalardo, Federico (AO SS. Antonio e Biagio e Cesare Arrigo)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	Cardiogenic shock (CS) includes several phenotypes with heterogenous hemodynamic features. Timely prognostication is warranted to identify patients requiring treatment escalation. We explored the association of the updated Society for Cardiovascular Angiography and Interventions (SCAI) stages classification with in-hospital mortality using a prospective national registry. Between March 2020 and February 2022 the Altshock-2 Registry has included 237 patients with CS of all etiologies at 11 Italian Centers. Patients were classified according to their admission SCAI stage (assigned prospectively and independently updated according to the recently released version). In-hospital mortality was evaluated for association with both admission and 24-h SCAI stages. The overall in-hospital mortality was 38%. Of the 237 patients included and staged according to the updated SCAI classification, 20 (8%) had SCAI shock stage B, 131 (55%) SCAI stage C, 61 (26%) SCAI stage D and 25 (11%) SCAI stage E. In-hospital mortality stratified according to the SCAI classification at 24 h was 18% for patients in SCAI stage B, 27% for SCAI stage C, 63% for SCAI stage D and 100% for SCAI stage E. Both the revised SCAI stages on admission and at 24 h were associated with in-hospital mortality, but the classification potential slightly increased at 24-h. After adjusting for age, sex, lactate level, eGFR, CVP, inotropic score and mechanical circulatory support [MCS], SCAI classification at 24 h was an independent predictor of in-hospital mortality. In the Altshock-2 registry the utility of SCAI shock stages to identify risk of in-hospital mortality increased at 24 h after admission. Escalation of treatment (either pharmacological or with MCS) should be tailored to achieve prompt clinical improvement within the first 24 h after admission. Registration: ; Unique identifier: NCT04295252.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Cardiogenic shock ; Heart failure ; SCAI stages
Published in:	Catheterization and Cardiovascular Interventions, Vol. 101 (november 2022) , p. 22-32, ISSN 1522-726X

DOI: 10.1002/ccd.30484
PMID: 36378673

11 p, 1.2 MB

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