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Published on: June 12, 2021
Using a Cardiogenic Shock Classification System for Predicting Postcardiotomy Shock Mortality
Yiwen Wang1, Chenglong Li1, Liangshan Wang1
1Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Cardiogenic shock (CS) in cardiac surgery patients is common, affecting 11.1%. The Society for Cardiovascular Angiography and Intervention (SCAI) classification effectively predicts in-hospital mortality risk, showing higher mortality with increased CS severity.
Area of Science:
- Cardiology
- Critical Care Medicine
- Cardiac Surgery
Background:
- Cardiogenic shock (CS) is a critical condition impacting hemodynamic stability.
- CS management varies with shock severity and patient population.
- The Society for Cardiovascular Angiography and Intervention (SCAI) introduced a new CS classification system.
Purpose of the Study:
- To evaluate parameters defining CS stages in postcardiotomy patients.
- To assess the diagnostic utility of the SCAI CS classification for predicting outcomes in cardiac surgery patients.
Main Methods:
- A retrospective observational study of 8,335 adult cardiac surgery patients (January-December 2022).
- Patients were stratified into 5 groups based on lactate levels and interventions (vasopressors, mechanical circulatory support).
- Primary outcome was in-hospital mortality.
Main Results:
- CS incidence was 11.1% (970 patients).
- Distribution across SCAI stages A-E showed significant differences (P < 0.001).
- In-hospital mortality progressively increased with CS severity, from 0.4% in Stage A to 31.0% in Stage E (P < 0.001). The AUC was 0.781.
Conclusions:
- CS affects 11.1% of postcardiotomy patients.
- SCAI-derived criteria for CS severity correlate well with in-hospital mortality in this population.
Background:
Cardiogenic shock (CS) is a life-threatening hemodynamic state. Patients with differing shock severity show varying responsiveness to clinical interventions. CS also occurs in patients who have undergone cardiac surgery. A few evaluation systems have been developed for postcardiotomy patients. The Society for Cardiovascular Angiography and Intervention (SCAI) has developed a new classification scheme for CS.
Objectives:
This study aimed to assess the parameters that define the stages of CS and the diagnostic utility of an SCAI-based CS classification system for patients undergoing cardiac surgery to inform the prediction of outcomes.
Methods:
This single-center, retrospective, observational study included 8,335 consecutive adult patients undergoing cardiac surgery from January to December 2022. This cohort was divided into 5 groups based on lactate and types of intervention received, including vasopressors and mechanical circulatory support systems. The primary outcome was in-hospital mortality.
Results:
CS occurred in 970 (11.1%) patients of this cohort. The frequencies of distribution of various postcardiotomy shock stages differed significantly: stage A = 4,747 (57.0%), stage B = 2,658 (31.9%), stage C = 779 (9.3%), stage D = 64 (0.8%), and stage E = 87 (1.0%) (P < 0.001) patients. In-hospital mortality was 1.1% (94 of 8,335). A progressive increase in the stage of the disease led to a clear stepwise increase in in-hospital mortality: Stage A = 0.4% (19 of 4747), Stage B = 0.8% (21 of 2658), Stage C = 2.8% (22 of 779), Stage D = 7.8% (5 of 64), and Stage E = 31.0% (27 of 87) (P < 0.001). The area under the receiver-operating curve of this classification for postcardiotomy CS was 0.781 (95% CI: 0.746-0.815).
Conclusions:
In this single-center postcardiotomy population, CS occurred in 11.1% of patients. Postcardiotomy SCAI-derived criteria for CS severity suggested a good correlation with in-hospital mortality.
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