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Published on: June 12, 2021
Invasive Hemodynamic Assessment and Classification of In-Hospital Mortality Risk Among Patients With Cardiogenic
Katherine L Thayer1, Elric Zweck1,2, Mohyee Ayouty3
1The CardioVascular Center, Tufts Medical Center, Boston, MA (K.L.T., E.Z., K.J.M., S.N., J.L.H., N.M.H., M.L.E., C.D.D., J.U., N.K.K.).
Insights
The Society for Cardiovascular Angiography and Interventions (SCAI) stages effectively risk-stratify patients with cardiogenic shock (CS), identifying those at higher risk for in-hospital mortality. Venous congestion is also a key indicator of mortality risk in CS patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Outcomes Research
Background:
- Risk stratification for cardiogenic shock (CS) is a critical unmet need.
- The Society for Cardiovascular Angiography and Interventions (SCAI) staging system is a proposed tool for identifying CS patients at risk of in-hospital mortality.
- The utility of SCAI stages and the impact of hemodynamic congestion on CS outcomes require further investigation.
Purpose of the Study:
- To evaluate the utility of the SCAI staging system in risk stratifying patients with cardiogenic shock.
- To explore the impact of hemodynamic congestion on clinical outcomes in patients with CS.
- To assess the association between SCAI stages, hemodynamic congestion, and in-hospital mortality.
Main Methods:
- Utilized the CS Working Group registry, including 1414 patients from 8 medical centers (2016-2019).
- Classified patients by maximum SCAI stage (B-E) based on treatment utilization.
- Analyzed in-hospital mortality in relation to SCAI stages and hemodynamic congestion parameters.
Main Results:
- In-hospital mortality was 31% overall, higher in myocardial infarction (MI) CS (41%) than heart failure (HF) CS (26%).
- Increasing SCAI stage was significantly associated with higher in-hospital mortality (OR, 3.25 [95% CI, 2.63-4.02]).
- Elevated right atrial pressure, indicating venous congestion, was linked to increased mortality and higher SCAI stages.
Conclusions:
- The SCAI staging system is associated with in-hospital mortality in patients with CS due to HF and MI.
- Venous congestion is prevalent in CS and independently identifies patients at high risk for mortality.
- Findings support the use of SCAI staging and monitoring venous congestion for improved CS management and clinical trial design.
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.
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