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[The Value of Using SCAI Cardiogenic Shock Stages in Predicting Mortality in CICU Patients]
Danzengzhuoga1,2, Zhi-Feng Zhao1, Mao Chen1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China.
Insights
The Society of Cardiovascular Imaging and Intervention (SCAI) stages effectively predict mortality in cardiogenic shock (CS) patients admitted to the cardiac intensive care unit (CICU). Combining SCAI stages with GRACE scores improves risk prediction for acute coronary syndrome patients with CS.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Risk Stratification
Background:
- Cardiogenic shock (CS) is a severe complication of cardiac dysfunction, associated with high mortality.
- Accurate risk stratification is crucial for timely and effective management of CS patients.
- The Society of Cardiovascular Imaging and Intervention (SCAI) developed a staging system for CS.
Purpose of the Study:
- To evaluate the predictive value of the SCAI CS stages for in-hospital mortality in cardiac intensive care unit (CICU) patients.
- To assess the added benefit of combining SCAI staging with the Global Registry of Acute Coronary Events (GRACE) score in predicting mortality for CS patients with acute coronary syndrome.
Main Methods:
- Retrospective analysis of 839 CS patients admitted to a CICU between January 2011 and January 2018.
- Patients were classified into SCAI stages C (Classic), D (Deteriorating), and E (Extremis).
- Logistic regression and receiver operating characteristic (ROC) curve analysis were used to assess mortality prediction.
Main Results:
- In-hospital mortality rates increased significantly across SCAI stages C (22.9%), D (44.0%), and E (53.6%) (P<0.001).
- SCAI staging demonstrated an area under the curve (AUC) of 0.640 for predicting mortality, which improved to 0.776 after multivariate adjustment (P<0.001).
- In acute coronary syndrome patients, combining SCAI stages with GRACE scores improved mortality prediction (AUC 0.702) compared to GRACE scores alone (AUC 0.644).
Conclusions:
- SCAI CS stages provide a valuable tool for rapid risk stratification of CS patients upon admission to the CICU.
- The combination of SCAI staging and GRACE scores enhances mortality risk prediction in CS patients with acute coronary syndrome.
Objective:
To study the value of using the cardiogenic shock (CS) stages developed by the Society of Cardiovascular Imaging and Intervention (SCAI) in predicting the mortality of CS patients in cardiac intensive care unit (CICU).
Methods:
We retrospectively collected (Jan., 2011-Jan., 2018) the information of inpatients who were admitted to the CICU of West China Hospital of Sichuan University on consecutive days, and conducted analysis on those with CS. The patients were divided into groups C, D and E, according to the corresponding SCAI stages, and the primary outcome indicator was in-hospital mortality. Logistic regression was done to determine the association between SCAI staging and in-hospital mortality before and after multivariate adjustment. The receiver operating characteristic curve was used to assess the value of SCAI stages of CS in predicting in-hospital mortality.
Results:
We studies 839 CS patients who met our inclusion criteria. The proportions of patients of SCAI stages C (Classic), D (Deteriorating), and E (Extremis) were 43.3% (363 cases), 38.7% (325 cases) and 18.0% (151 cases), respectively. The unadjusted in-hospital mortality rates were 22.9% (83 cases), 44.0% (143 cases) and 53.6% (81 cases), respectively ( P<0.001). The SCAI stages had an AUC (area under the curve) of 0.640 for predicting in-hospital mortality among CS patients in CICU. After multivariate adjustment, the AUC increased to 0.776 ( P<0.001). In patients with acute coronary syndrome, the Global Registry of Acute Coronary Events (GRACE) scores had an AUC of 0.644 for predicting in-hospital mortality, while a combination of the GRACE score with SCAI staging yielded an increased AUC of 0.702 ( P<0.001).
Conclusion:
In CICU patients with CS, the SCAI stages of CS can be used as a stratified method for rapid assessment of disease risks upon admission. In patients with acute coronary syndrome and CS, SCAI stages combined with GRACE scores improved the ability to predict risks of death.
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