Distribution and 24-hour transition of SCAI shock stages and their association with 30-day mortality in acute myocardial infarction

Area of Science:

• Cardiology
• Critical Care Medicine
• Clinical Research

Background:

• The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification is a validated predictor of mortality in acute myocardial infarction (AMI).
• Limited data exist on the dynamic changes in SCAI shock stages post-AMI and their correlation with patient outcomes.
• Understanding SCAI stage transitions is crucial for refining prognostic assessments in AMI patients.

Purpose of the Study:

• To investigate the association between transitions in SCAI shock stages and 30-day mortality in patients with AMI.
• To determine if reevaluating SCAI stages after 24 hours provides additional prognostic value beyond initial assessment.

Main Methods:

• A prospective study included 139 AMI patients classified by SCAI stages (A, B, C/D/E) at admission and 24 hours.
• Kaplan-Meier estimates and multivariable Cox regression analyses were used to assess the relationship between SCAI stage changes and 30-day mortality.
• Patients were categorized based on initial SCAI stage and changes observed within 24 hours.

Main Results:

• On admission, 50.4% were SCAI stage A, 20.1% stage B, and 29.5% stages C/D/E.
• After 24 hours, 14.4% improved, 66.2% remained stable, and 19.4% worsened.
• 30-day mortality rates were 2.9% (initial A), 21.4% (initial B), and 61.0% (initial C/D/E). Mortality was significantly higher (92.6%) in patients whose SCAI stage worsened by 24 hours.

Conclusions:

• Dynamic assessment of SCAI shock stages in AMI patients, both at admission and after 24 hours, significantly enhances 30-day mortality prediction.
• Worsening SCAI stage within 24 hours is strongly associated with increased mortality.
• Serial SCAI staging provides valuable prognostic information for managing AMI patients.