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Predictive value of the cardiogenic shock working group-modified SCAI criteria in early-stage heart failure-related
Tijmen H Ris1, Morsal Atazadah1, Roel Hoek1
1Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
Insights
The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) stage at diagnosis did not predict mortality in early heart failure with cardiogenic shock (HF-CS). However, CSWG-SCAI at 24 hours, 48 hours, and maximum stage predicted mortality, with minimal improvement from adding urine output.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging system is validated for cardiogenic shock (CS).
- Its prognostic utility in early-stage heart failure with cardiogenic shock (HF-CS) remains under-investigated.
Purpose of the Study:
- To assess the prognostic value of the CSWG-SCAI staging system in patients with early-stage HF-CS.
- To evaluate the added predictive value of urine output (UO) to the CSWG-SCAI classification.
Main Methods:
- A cohort of 208 patients with HF-CS was analyzed.
- The relationship between CSWG-SCAI stages (at diagnosis, 24h, 48h, maximum) and in-hospital mortality was examined.
- The incremental predictive value of incorporating UO into the CSWG-SCAI (SCAI-UO) was evaluated.
Main Results:
- At diagnosis, CSWG-SCAI stages A and B were most prevalent; stage C dominated later.
- In-hospital mortality was 42%.
- CSWG-SCAI at diagnosis showed no prognostic value (p=0.994), but was associated with mortality at 24h (p=0.005), 48h (p=0.005), and maximum stage (p<0.001). Stage deterioration after 24h predicted mortality (p<0.001). SCAI-UO offered modest additive value at 48h (AUC 0.70 vs 0.67) and maximum stage (AUC 0.69 vs 0.66).
Conclusions:
- The CSWG-SCAI classification at HF-CS diagnosis may not adequately predict in-hospital mortality in early stages.
- The CSWG-SCAI staging system becomes prognostic at 24h, 48h, and maximum stage.
- Integrating UO into CSWG-SCAI provides minimal improvement in risk stratification.
Background:
The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) has been validated in patients with cardiogenic shock (CS) related to heart failure (HF). Its prognostic value in patients with early-stage HF-CS has been scarcely investigated.
Methods:
In 208 patients with HF-CS, the relationship between the CSWG-SCAI stage at diagnosis, at 24 and 48 h, the maximum CSWG-SCAI stage, and in-hospital mortality were assessed. In addition, the added value of urine output (UO) to the CSWG-SCAI was evaluated.
Results:
At HF-CS diagnosis, stages A and B were most prevalent (33 % and 36 %), while stage C dominated at 24 h (51 %), 48 h (44 %) and maximum CSWG-SCAI (37 %). In total, 87 (42 %) patients died during hospitalization. At HF-CS diagnosis, lower stages (A/B) showed similar prognostic value compared to more severe stages (C/D/E) (p = 0.994). The CSWG-SCAI was associated with in-hospital mortality at 24 h (p = 0.005), 48 h (p = 0.005) and at maximum CSWG SCAI (p < 0.001). Stage deterioration after 24 h was associated with mortality (deteriorated vs. improved: p < 0.001). SCAI-UO showed modest additive predictive value at 48 h (AUC 0.67 vs. AUC 0.70; p = 0.015) and maximum SCAI compared to CSWG-SCAI (AUC 0.66 vs. AUC 0.69; p = 0.032).
Conclusions:
At the time of HF-CS diagnosis, the CSWG-SCAI classification failed to predict in-hospital mortality, suggesting that it may not adequately capture the severity of early-stage HF-CS. The CSWG-SCAI classification was associated with in-hospital mortality at 24 and 48 h and at maximum CSWG-SCAI. Incorporating UO into the CSWG-SCAI criteria minimally improved risk stratification.
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