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Multicenter Study
. 2020 Nov;96(6):1137-1142.
doi: 10.1002/ccd.29139. Epub 2020 Jul 16.

SCAI shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative

Ivan D Hanson  1 , Travis Tagami  1 , Ramy Mando  1 , Abdalla Kara Balla  1 , Simon R Dixon  1 , Steven Timmis  1 , Steven Almany  1 , Srihari S Naidu  2 , David Baran  3 , Alejandro Lemor  4 , Sarah Gorgis  4 , William O'Neill  4 , Mir B Basir  4 ; National Cardiogenic Shock Investigators
Affiliations
Multicenter Study

SCAI shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative

Ivan D Hanson et al. Catheter Cardiovasc Interv. 2020 Nov.

Abstract

Objectives: We applied the cardiovascular angiography and interventions (SCAI) shock staging system to patients presenting with acute myocardial infarction and cardiogenic shock (AMI-CS) who were enrolled in the National Cardiogenic Shock Initiative (NCSI).

Background: The SCAI shock staging system provides a framework for evaluation of patients with CS based on clinical and hemodynamic parameters, but has not been validated in patients with AMI-CS managed with a contemporary treatment algorithm that incorporates early use of Impella.

Methods: Consecutive patients enrolled in NCSI were identified, all of whom were managed with invasive hemodynamic guidance and supported with Impella. Patients were retrospectively categorized into appropriate SCAI shock stages, and outcomes were assessed accordingly.

Results: A total of 300 patients were included in the analysis; 182 patients (61%) presented in Stage C shock, 25 (8%) in Stage D, and 93 (31%) in Stage E. Survival to hospital discharge was 76, 76, and 58%, respectively (p = .006). Survival was <20% among patients in Stage E at 24 hr, regardless of baseline stage. There was near perfect agreement in shock staging between two independent clinicians at baseline (kappa = 0.975, 95% CI, 0.95-1.00, p < .001) and at 24 hr (kappa = 0.985, 95% CI, 0.77-1.00, p < .001).

Conclusion: In patients with AMI-CS enrolled in NCSI, SCAI Shock classification was reproducible, and predicted survival when applied at presentation and at 24 hr.

Keywords: SCAI shock stage; acute myocardial infarction; cardiogenic shock; impella.

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References

REFERENCES

    1. Shah RU, de Lemos JA, Wang TY, et al. Post-hospital outcomes of patients with acute myocardial infarction with cardiogenic shock: findings from the NCDR. J Am Coll Cardiol. 2016;67:739-747.
    1. Baran DA, Grines CL, Bailey S, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock: this document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv. 2019;94:29-37.
    1. Basir MB, Schreiber TL, Grines CL, et al. Effect of early initiation of mechanical circulatory support on survival in cardiogenic shock. Am J Cardiol. 2017;119:845-851.
    1. Dhruva SS, Ross JS, Mortazavi BJ, et al. Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2020;323:734.
    1. Schrage B, Ibrahim K, Loehn T, et al. Impella support for acute myocardial infarction complicated by cardiogenic shock. Circulation. 2019;139:1249-1258.

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