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Serial Shock Severity Assessment Within 72 Hours After Diagnosis: A Cardiogenic Shock Working Group Report
Van-Khue Ton1, Song Li2, Kevin John3
1Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Most cardiogenic shock (CS) patients change stages within 24 hours. Early recognition and serial assessment of CSWG-SCAI stages are crucial for risk stratification, especially for Stage B patients who face high mortality risk.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging system aids in risk stratifying cardiogenic shock (CS) severity.
- Limited data exist on progressive changes in SCAI stages and their impact on patient outcomes.
Purpose of the Study:
- To investigate serial changes in CSWG-SCAI stages and outcomes in patients with CS complicating acute myocardial infarction (MI-CS) and heart failure-related CS (HF-CS).
Main Methods:
- Utilized data from the multicenter CSWG registry.
- Calculated CSWG-SCAI stages at CS diagnosis and at 24, 48, and 72 hours post-diagnosis.
Main Results:
- Over 3,200 patients were analyzed, with 57% having HF-CS and 27% MI-CS.
- More than 50% of patients in stages B and C worsened within 24 hours, while 86% of stage D patients remained at stage D.
- Patients progressing to or presenting in stage E within 24 hours had the highest mortality rates; survivors had lower lactate levels.
Conclusions:
- Significant CSWG-SCAI stage changes occur within the first 24 hours of CS diagnosis.
- Stage B patients are at high risk of deterioration and associated mortality.
- Serial assessment of CSWG-SCAI stages is vital for timely risk stratification and management.
Background:
The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging was developed to risk stratify cardiogenic shock (CS) severity. Data showing progressive changes in SCAI stages and outcomes are limited.
Objectives:
We investigated serial changes in CSWG-SCAI stages and outcomes of patients presenting with cardiogenic shock complicating acute myocardial infarction (MI-CS) and heart failure-related CS (HF-CS).
Methods:
The multicenter CSWG registry was queried. CSWG-SCAI stages were computed at CS diagnosis and 24, 48, and 72 hours.
Results:
A total of 3,268 patients (57% HF-CS; 27% MI-CS) were included. At CS diagnosis, CSWG-SCAI stage breakdown was 593 (18.1%) stage B, 528 (16.2%) stage C, 1,659 (50.8%) stage D, and 488 (14.9%) noncardiac arrest stage E. At 24 hours, >50% of stages B and C patients worsened, but 86% of stage D patients stayed at stage D. Among stage E patients, 54% improved to stage D and 36% stayed at stage E by 24 hours. Minimal SCAI stage changes occurred beyond 24 hours. SCAI stage trajectories were similar between MI-CS and HF-CS groups. Within 24 hours, unadjusted mortality rates of patients with any SCAI stage worsening or improving were 44.6% and 34.2%, respectively. Patients who presented in or progressed to stage E by 24 hours had the worst prognosis. Survivors had lower lactate than nonsurvivors.
Conclusions:
Most patients with CS changed SCAI stages within 24 hours from CS diagnosis. Stage B patients were at high risk of worsening shock severity by 24 hours, associated with excess mortality. Early CS recognition and serial assessment may improve risk stratification.
