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Published on: June 12, 2021
Consistency and Risk Stratification Performance of 4 Society for Cardiovascular Angiography and Interventions SHOCK
Tobias Becher1,2,3, Leonie Hahn1,2,3, Markward Britsch1,2,3,4,5,6,7
1Cardiology, Haemostaseology, and Medical Intensive Care, Medical Centre Mannheim, Medical Faculty Mannheim Heidelberg University Heidelberg Germany.
Insights
Different definitions for the Society for Cardiovascular Angiography and Interventions (SCAI) SHOCK Stage Classification showed moderate agreement in assessing cardiogenic shock (CS). All frameworks effectively stratified patients by severity, with similar predictive performance for in-hospital death.
Area of Science:
- Cardiology
- Clinical Research
Background:
- Cardiogenic shock (CS) presents a critical challenge with high mortality rates, necessitating precise diagnostic tools.
- The Society for Cardiovascular Angiography and Interventions (SCAI) SHOCK Stage Classification is a key instrument for CS assessment and outcome prediction.
Purpose of the Study:
- To evaluate the impact of varying parameter definitions on SCAI SHOCK stage adjudication.
- To assess how definition variations influence CS assessment and patient stratification.
Main Methods:
- Retrospective analysis of 1281 patients diagnosed with CS between January 2018 and June 2022.
- Assignment of SCAI SHOCK stages based on four distinct published classification frameworks.
- Assessment of stage distribution, outcomes, classification concordance, and predictive performance.
Main Results:
- A high concordance (98.2%) was observed across the four SCAI SHOCK classification frameworks.
- Moderate to strong overall classification agreement (Kendall's W=0.70) was found, despite variations in stage assignment and mortality rates.
- No significant differences in the predictive performance for in-hospital mortality were detected among the frameworks.
Conclusions:
- The study confirms moderate to strong concordance and comparable prognostic performance of different SCAI SHOCK Stage Classification frameworks.
- All frameworks successfully stratified patients based on clinical severity, underscoring their utility in CS evaluation.
- Standardization of the SCAI SHOCK Stage Classification system is recommended for consistent retrospective study assignments.
Background:
Cardiogenic shock (CS) is a critical condition associated with high mortality rates, making prompt diagnosis essential for timely interventions that may improve patient outcomes. The Society for Cardiovascular Angiography and Interventions (SCAI) SHOCK Stage Classification is a validated tool for assessing CS and predicting patient outcomes. Here, we evaluated how different parameter definitions affect SCAI stage adjudication, hypothesizing that variations may influence stage determination and the overall assessment of CS.
Methods:
All patients diagnosed with CS or conditions leading to CS at the University Medical Center Mannheim, Germany, from January 2018 to June 2022 were included in the study. SCAI SHOCK stages were assigned retrospectively on the basis of 4 previously published studies. The distribution of SCAI SHOCK stages, outcomes, classification concordance, and predictive performance were assessed.
Results:
From January 2018 to June 2022, we identified 1303 patients on the basis of International Classification of Diseases, Tenth Revision (ICD-10) codes. Of these, 1281 patients (98.2%) were classified into SCAI SHOCK stages according to all 4 classification frameworks. While the assignment of SCAI SHOCK stages and associated mortality rates varied among the frameworks, Kendall's W indicated moderate to strong overall classification agreement (W=0.70). There was no significant difference in predictive performance for in-hospital death.
Conclusions:
Our study demonstrates a moderate to strong concordance and comparable prognostic performance across different SCAI SHOCK Stage Classification frameworks in evaluating patients with CS. Despite differences in stage assignments, all frameworks effectively stratified patients by clinical severity. Comparable stage assignment in retrospective studies requires further standardization of the SCAI SHOCK Stage Classification system.
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