Risk stratification using the SCAI SHOCK classification in patients with acute pulmonary embolism

Area of Science:

• Cardiology
• Pulmonary Medicine
• Critical Care Medicine

Background:

• Pulmonary embolism (PE) is a major cause of cardiovascular death.
• High-risk PE patients have varied outcomes, and current systems don't distinguish vasopressor use from cardiac arrest.
• This study uses the SCAI shock classification for PE risk stratification.

Purpose of the Study:

• To apply the SCAI shock classification to stratify high-risk PE patients.
• To assess mortality differences across SCAI shock stages in PE.
• To evaluate treatment modalities and outcomes based on shock severity.

Main Methods:

• Analysis of the Nationwide Inpatient Sample (NIS) database (2017-2020).
• Categorization of adult PE hospitalizations into SCAI shock stages A/B, C/D, and E.
• Multivariate logistic regression to adjust for confounders and analyze outcomes like mortality and complications.

Main Results:

• Mortality increased significantly with shock severity: 2.13% (Stage A/B), 39.90% (Stage C/D), and 65.95% (Stage E).
• Stage C/D and E patients had substantially higher adjusted odds of mortality (13.9x and 54.8x, respectively).
• Surgical thrombectomy showed lower mortality compared to systemic thrombolysis for Stage C/D and E PE.

Conclusions:

• The SCAI shock classification provides precise mortality risk stratification for high-risk PE.
• Cardiac arrest in PE patients is associated with significantly higher mortality than vasopressor requirement alone.
• Further research should integrate hemodynamic parameters and biomarkers for optimized treatment selection in PE.