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SCAI Cardiogenic Shock Classification for Predicting In-Hospital and Long-Term Mortality in Acute Heart Failure
Lucrecia María Burgos1, Rocío Consuelo Baro Vila1, Fernando Botto2
1Heart Failure, Pulmonary Hypertension and Transplant Department, Buenos Aires, Argentina.
Insights
The Society for Cardiovascular Angiography and Interventions (SCAI) classification effectively predicts mortality in patients with acute heart failure (AHF). This classification system aids in assessing risk for both in-hospital and long-term outcomes in AHF patients.
Area of Science:
- Cardiology
- Acute Heart Failure Management
- Clinical Risk Stratification
Background:
- The Society for Cardiovascular Angiography and Interventions (SCAI) classification is recognized for its utility in assessing cardiogenic shock.
- Its predictive value in primary acute heart failure (AHF) requires further investigation.
Purpose of the Study:
- To evaluate the predictive capability of the SCAI classification for in-hospital and long-term mortality in patients with AHF.
Main Methods:
- A retrospective analysis of prospectively collected data from 856 consecutive AHF patients admitted between 2015 and 2020.
- Primary endpoints included in-hospital and all-cause long-term mortality.
- Multivariable adjustment was performed to assess the association between SCAI SHOCK stages and mortality.
Main Results:
- Unadjusted in-hospital mortality rates increased significantly across SCAI stages A through E (0.6% to 90.6%).
- Long-term mortality also demonstrated a significant increase across SCAI stages (24.9% to 95.5%).
- After multivariable adjustment, all SCAI SHOCK stages were associated with increased mortality compared to stage A, with no significant difference between stages A and B for adjusted mortality regarding the long-term endpoint.
Conclusions:
- The SCAI cardiogenic shock classification is a valuable tool for predicting in-hospital and long-term mortality in AHF patients.
- These findings support the use and rationale of the SCAI classification within the context of acute heart failure management.
Background:
SCAI classification in cardiogenic shock is simple and suitable for rapid assessment. Its predictive behavior in patients with primary acute heart failure (AHF) is not fully known. We aimed to evaluate the ability of the SCAI classification to predict in-hospital and long-term mortality in AHF.
Methods:
We conducted a single-center study and performed a retrospective analysis of prospectively collected data of consecutive patients admitted with AHF between 2015 and 2020. The primary end points were in-hospital and long-term mortality from all causes.
Results:
In total, 856 patients were included. The unadjusted in-hospital mortality was as follows: A, 0.6%; B, 2.7%; C, 21.5%; D 54.3%; and E, 90.6% (log rank, P < .0001), and long-term mortality was as follows: A, 24.9%; B, 24%; C, 49.6%; D, 62.9%; and E, 95.5% (log rank, P < .0001). After multivariable adjustment, each SCAI SHOCK stage remained associated with increased mortality (all P < .001 compared with stage A). With the exception of the long-term end point, there were no differences between stages A and B for adjusted mortality (P = .1).
Conclusions:
In a cohort of patients with AHF, SCAI cardiogenic shock classification was associated with in-hospital and long-term mortality. This finding supports the rationale of the classification in this setting.
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