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Prognostic Utility of Society for Cardiovascular Angiography and Interventions Shock Stage Approach for Classifying
Andrea Camblor-Blasco1, Ivan J Nuñez-Gil2,3, Albert Duran Cambra4
1Cardiology Department Hospital Universitari Vall d'Hebron Barcelona Spain.
Insights
The Society for Cardiovascular Angiography and Interventions (SCAI) shock staging system effectively predicts mortality in Takotsubo syndrome (TTS) patients with cardiogenic shock (CS). Higher SCAI stages correlate with increased in-hospital and 1-year mortality.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Clinical Research
Background:
- Cardiogenic shock (CS) is a severe complication of Takotsubo syndrome (TTS), increasing mortality.
- The Society for Cardiovascular Angiography and Interventions (SCAI) staging system for CS severity lacks validation in TTS patients.
- This study evaluated the SCAI staging system's utility in TTS with CS.
Purpose of the Study:
- To characterize a patient cohort with TTS using the SCAI staging system.
- To assess the SCAI staging system's prognostic value in TTS complicated by CS.
- To validate the SCAI staging system for CS severity in TTS.
Main Methods:
- Utilized a national TTS registry, enrolling 1591 patients and stratifying them into 5 SCAI stages (A-E).
- Final cohort comprised 1163 patients (mean age 71.0±11.8 years, 87% female).
- Analyzed in-hospital mortality, TTS-related complications, and 1-year mortality, with multivariable adjustments.
Main Results:
- Patients distributed across SCAI stages: A (72.1%), B (12.2%), C (11.2%), D (2.7%), E (1.8%).
- Significant variations in demographics, comorbidities, and clinical presentations across stages.
- Each higher SCAI stage significantly increased in-hospital mortality (aOR: 1.77-29.31) and 1-year mortality compared to stage A.
Conclusions:
- The SCAI shock stage classification effectively stratified mortality risk in TTS patients with CS.
- A continuum of escalating shock severity was observed, with higher stages correlating with increased mortality.
- The SCAI staging system demonstrates applicability and prognostic value in TTS-related CS.
Background:
Cardiogenic shock (CS) is a significant complication of Takotsubo syndrome (TTS), contributing to heightened mortality and morbidity. Despite this, the Society for Cardiovascular Angiography and Interventions (SCAI) staging system for CS severity lacks validation in patients with TTS and CS. This study aimed to characterize a patient cohort with TTS using the SCAI staging system and assess its utility in cases of TTS complicated by CS.
Methods And Results:
From a TTS national registry, 1591 consecutive patients were initially enrolled and stratified into 5 SCAI stages (A through E). Primary outcome was all-cause in-hospital mortality; secondary end points were TTS-related in-hospital complications and 1-year all-cause mortality. After exclusions, the final cohort comprised 1163 patients, mean age 71.0±11.8 years, and 87% were female. Patients were categorized across SCAI shock stages as follows: A 72.1%, B 12.2%, C 11.2%, D 2.7%, and E 1.8%. Significant variations in baseline demographics, comorbidities, clinical presentations, and in-hospital courses were observed across SCAI shock stages. After multivariable adjustment, each higher SCAI shock stage showed a significant association with increased in-hospital mortality (adjusted odds ratio: 1.77-29.31) compared with SCAI shock stage A. Higher SCAI shock stages were also associated with increased 1-year mortality.
Conclusions:
In a large multicenter patient cohort with TTS, the functional SCAI shock stage classification effectively stratified mortality risk, revealing a continuum of escalating shock severity with higher stages correlating with increased in-hospital mortality. This study highlights the applicability and prognostic value of the SCAI staging system in TTS-related CS.
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