Distribution and 24-hour transition of SCAI shock stages and their association with 30-day mortality in acute myocardial infarction

Abstract

The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification has been shown to predict mortality in acute myocardial infarction (AMI). However, data on the transition of SCAI stages and their association with mortality after AMI are limited. All patients with AMI admitted to Vietnam National Heart Institute between August 2022 and February 2023 were classified into SCAI stages A, B, and C/D/E at admission and were reevaluated in 24 hours. We used Kaplan-Meier estimate and multivariable Cox regression analysis to assess the association between SCAI stages transition and 30-day mortality. We included 139 patients (median age 69 years, 29.5% female). On admission, 50.4%, 20.1%, and 29.5% of patients were classified as SCAI stage A, B, and C/D/E, respectively. The proportion of patients whose SCAI stage improved, remained stable, or worsened after 24 hours was 14.4%, 66.2%, and 19.4%, respectively. The 30-day mortality in patients with initial SCAI stages A, B, and C/D/E on admission was 2.9%, 21.4%, and 61.0%, respectively (P < .001). The 30-day mortality was 2.4% for patients with baseline SCAI stage A/B who remained unchanged or improved, 30.0% for patients with baseline SCAI stage C/D/E who remained unchanged or improved, and 92.6% for patients with SCAI stage B/C/D/E who worsened at 24 hours after admission (log-rank P < .001). In patients with AMI, evaluating the SCAI stage shock stage on admission and reevaluating after 24 hours added more information about 30-day mortality.

Figure 1.

Kaplan–Meir estimates of 30-day mortality by SCAI stage on hospital admission in patients with acute myocardial infarction. SCAI: Society for Cardiovascular Angiography and Interventions shock classification.

Figure 2.

Kaplan–Meir estimates of 30-day mortality by 24-hour SCAI stage transition in patients with acute myocardial infarction. Panel A: Survival by baseline SCAI stage and change in SCAI stage after 24 hours. Panel B: Survival by restructured groups of SCAI stage transition. SCAI: Society for Cardiovascular Angiography and Interventions shock classification.