CARD22: Defining Baseline and Maximum Stages of Cardiogenic Shock Severity: Insights from the Cardiogenic Shock Working Group

Résumé fourni par la source

Background: Risk stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) Staging system for CS severity lacks uniform criteria defining each Stage. Objectives: To test parameters that define SCAI Stages and explore their utility as predictors of in-hospital mortality in CS. Methods: The CS Working Group registry includes patients from 17 hospitals enrolled between 2016-2021 and was used to define clinical profiles for CS. We selected parameters of hypotension and hypoperfusion and treatment intensity, confirmed their association with mortality, then defined formal criteria for each Stage and tested the association between both baseline and maximum Stage and mortality (see figure panel A). Results: Of the 3455 patients, CS was due to HF (52%) or MI (32%). Mortality was 35% for the total cohort and higher among patients with MI compared to those with HF (42% v. 25%, p<0.0001). Out of hospital cardiac arrest (OR: 2.50, p< 0.001) and increasing use of vasopressors, inotropes or acute mechanical circulatory support devices (OR: 2.30. p<0.001) were associated with increased with increased risk of in-hospital mortality. Increasing systolic blood pressure (OR: 1.15, p=0.001), lactate level (OR:1.15, p<0.001), alanine transaminase level (OR: 1.000, p<0.001), and systemic pH (OR:0.024, p<0.001) were significantly associated with mortality continuously and categorically based on clinically relevant cut offs so these cut offs were used to define each Stage. Once assigned across various points across hospitalization among patients with all available data (n=1890), higher baseline (B: 24.0% v. C: 19.5% v. D: 36.5% v. E: 52.9%, p<0.001) and maximum Stages (B: 15.38% v. C: 6.58% v. D: 27.86% v. E: 63.14%, p<0.001) were significantly associated with mortality. Lower baseline Stage was associated with a higher incidence of Stage escalation and a shorter duration to reach maximum Stage. Patients who progressed to Stage E, regardless of their baseline stage, had a greater likelihood of in-hospital mortality (see figure panel B). Conclusions: We report a novel approach to define SCAI stages and identified a significant association between baseline and maximum Stage and mortality. This approach may improve clinical application of the Staging system and provides new insight into the trajectory of hospitalized CS patients.

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