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ABSTRACT: Background
Risk stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) stages as an approach to identify patients at risk for in-hospital mortality remains under investigation. We studied the utility of the SCAI stages and further explored the impact of hemodynamic congestion on clinical outcomes.Methods
The CS Working Group registry includes patients with CS from 8 medical centers enrolled between 2016 and 2019. Patients were classified by the maximum SCAI stage (B-E) reached during their hospital stay according to drug and device utilization. In-hospital mortality was evaluated for association with SCAI stages and hemodynamic congestion.Results
Of the 1414 patients with CS, the majority were due to decompensated heart failure (50%) or myocardial infarction (MI; 35%). In-hospital mortality was 31% for the total cohort, but higher among patients with MI (41% versus 26%, MI versus heart failure, P<0.0001). Risk for in-hospital mortality was associated with increasing SCAI stage (odds ratio [95% CI], 3.25 [2.63-4.02]) in both MI and heart failure cohorts. Hemodynamic data was available in 1116 (79%) patients. Elevated biventricular filling pressures were common among patients with CS, and right atrial pressure was associated with increased mortality and higher SCAI Stage.Conclusions
Our findings support an association between the proposed SCAI staging system and in-hospital mortality among patient with heart failure and MI. We further identify that venous congestion is common and identifies patients with CS at high risk for in-hospital mortality. These findings provide may inform future management protocols and clinical studies.
SUBMITTER: Thayer KL
PROVIDER: S-EPMC10243474 | biostudies-literature | 2020 Sep
REPOSITORIES: biostudies-literature
Thayer Katherine L KL Zweck Elric E Ayouty Mohyee M Garan A Reshad AR Hernandez-Montfort Jaime J Mahr Claudius C Morine Kevin J KJ Newman Sarah S Jorde Lena L Haywood Jillian L JL Harwani Neil M NM Esposito Michele L ML Davila Carlos D CD Wencker Detlef D Sinha Shashank S SS Vorovich Esther E Abraham Jacob J O'Neill William W Udelson James J Burkhoff Daniel D Kapur Navin K NK
Circulation. Heart failure 20200909 9
<h4>Background</h4>Risk stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) stages as an approach to identify patients at risk for in-hospital mortality remains under investigation. We studied the utility of the SCAI stages and further explored the impact of hemodynamic congestion on clinical outcomes.<h4>Methods</h4>The CS Working Group registry includes patients with CS from 8 medical cent ...[more]