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Multicenter Study
. 2020 Sep;13(9):e007099.
doi: 10.1161/CIRCHEARTFAILURE.120.007099. Epub 2020 Sep 9.

Invasive Hemodynamic Assessment and Classification of In-Hospital Mortality Risk Among Patients With Cardiogenic Shock

Katherine L Thayer  1 , Elric Zweck  1   2 , Mohyee Ayouty  3 , A Reshad Garan  4 , Jaime Hernandez-Montfort  5 , Claudius Mahr  6 , Kevin J Morine  1 , Sarah Newman  1 , Lena Jorde  3 , Jillian L Haywood  1 , Neil M Harwani  1 , Michele L Esposito  1 , Carlos D Davila  1 , Detlef Wencker  7 , Shashank S Sinha  8 , Esther Vorovich  9 , Jacob Abraham  10 , William O'Neill  11 , James Udelson  1 , Daniel Burkhoff  12 , Navin K Kapur  1
Affiliations
Multicenter Study

Invasive Hemodynamic Assessment and Classification of In-Hospital Mortality Risk Among Patients With Cardiogenic Shock

Katherine L Thayer et al. Circ Heart Fail. 2020 Sep.

Abstract

Background: Risk stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) stages as an approach to identify patients at risk for in-hospital mortality remains under investigation. We studied the utility of the SCAI stages and further explored the impact of hemodynamic congestion on clinical outcomes.

Methods: The CS Working Group registry includes patients with CS from 8 medical centers enrolled between 2016 and 2019. Patients were classified by the maximum SCAI stage (B-E) reached during their hospital stay according to drug and device utilization. In-hospital mortality was evaluated for association with SCAI stages and hemodynamic congestion.

Results: Of the 1414 patients with CS, the majority were due to decompensated heart failure (50%) or myocardial infarction (MI; 35%). In-hospital mortality was 31% for the total cohort, but higher among patients with MI (41% versus 26%, MI versus heart failure, P<0.0001). Risk for in-hospital mortality was associated with increasing SCAI stage (odds ratio [95% CI], 3.25 [2.63-4.02]) in both MI and heart failure cohorts. Hemodynamic data was available in 1116 (79%) patients. Elevated biventricular filling pressures were common among patients with CS, and right atrial pressure was associated with increased mortality and higher SCAI Stage.

Conclusions: Our findings support an association between the proposed SCAI staging system and in-hospital mortality among patient with heart failure and MI. We further identify that venous congestion is common and identifies patients with CS at high risk for in-hospital mortality. These findings provide may inform future management protocols and clinical studies.

Keywords: cardiogenic shock; heart failure; hemodynamics; hospital mortality; myocardial infarction; right atrial pressure; ventricular congestion.

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Conflict of interest statement

Disclosures

NKK receives consulting/speaker honoraria and institutional grant support from: Abbott Laboratories, Abiomed Inc., Boston Scientific, Medtronic, LivaNova, MDStart, and Precardia. JHM is a consultant for Abiomed Inc. JA is a consultant for Abbott Laboratories, Abiomed Inc. DB reports an unrestricted, educational grant from Abiomed Inc. to Cardiovascular Research Foundation. SSS is a consultant for Abiomed Inc. (Critical Care Advisory Board). WON receives consulting/speaker honoraria from Abiomed Inc. KLT, EZ, MA, ARG, JHM, CM, KM, SN, LJ, MLE, CDD, DW, EV, NMH, JLH have nothing to disclose.

Figures

Figure 1.
Figure 1.
Definition, retrospective adjudication and distribution of SCAI stages within the CSWG registry
Figure 2.
Figure 2.
Device usage among CSWG patients with available hemodynamic data among the entire study cohort and each SCAI stage
Figure 3.
Figure 3.
In-hospital mortality by SCAI stage among different etiologies of shock. ***: p ≤ 0.001
Figure 4.
Figure 4.
Adjudication and distribution of congestion profiles among the CSWG study population with available hemodynamic data
Figure 5.
Figure 5.
A. Comparisons of mortality across congestion profiles among he overall, MI, and HF study cohorts. Comparisons adjusted by Bonferroni. B. Distribution of congestion profiles across SCAI stages. *: p ≤ 0.05, ***: p ≤ 0.001
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