SCAI Staging Application for Acute Myocardial Infarction-Related Cardiogenic Shock at a Single-Center Russian Registry

Abstract

Aim: To access the features of the course of myocardial infarction (MI) in patients with different stages of MI complicated by cardiogenic shock (MI CS) according to the SCAI scale.

Methods: We retrospectively described the portrait of CS MI (n = 117) at different stages of SCAI from the hospital MI registry (n = 1253).

Results: Hospital mortality increased from stage to stage (p ≤ 0.001). Significant differences in biochemical parameters were found both for indicators characterizing intensive care measures, such as the presence of mechanical lung ventilation or an intra-aortic balloon pump, and for indicators of organ hypoperfusion such as lactate level, pHv (7.39 (7.36; 7.44) at stage A-B; 7.14 (7.06; 7.18) at stage E), creatinine, and glomerular filtration rate. Parameters related to MI characteristics, such as instrumental and laboratory data, anamnesis of ischemia, and performed treatment, did not differ between groups. Polynomial logistic regression showed that lactate level, mechanical ventilation, and monocyte count upon admission (1.15 (0.96; 1.23) at stage A-B; 0.78 (0.49; 0.94) at stage E, p = 0.005) correlated with CS severity.

Conclusion: The characteristics of MI at different stages of SCAI do not have differences and do not determine the severity of shock. We revealed a high discriminatory potential of the pH level in predicting refractory shock. The value of monocytes at admission may be a promising predictor of the severity of MI CS. The question of the causes of heterogeneity of MI CS, taking into account the homogeneity of MI characteristics, remains open and promising.

Keywords: SCAI; acute coronary syndrome; cardiogenic shock; myocardial infarction.

Figure 1

Design of the study. Footnotes: Abbreviations: CS, cardiogenic shock; ICU, intensive care unit.

Figure 2

Level of pHv at admission. Footnotes. A—at risk; B—beginning (hypotension without hypoperfusion); C—classic (hypoperfusion without deterioration); D—deteriorating (hypoperfusion with deterioration); E—extremis (hypoperfusion with deterioration and refractory shock).

Figure 3

Dependence of the probability of classification into a group with a given level of SCAI on the average values of pHv. Footnotes: A = at risk; B = beginning (hypotension without hypoperfusion); C = classic (hypoperfusion without deterioration); D = deteriorating (hypoperfusion with deterioration); E = extremis (hypoperfusion with deterioration and refractory shock).

Figure 4

Levels of monocytes at admission. Footnotes: A—at risk; B—beginning (hypotension without hypoperfusion); C—classic (hypoperfusion without deterioration); D—deteriorating (hypoperfusion with deterioration); E—extremis (hypoperfusion with deterioration and refractory shock).

Figure 5

Distribution of SCAI SHOCK stages in each study [27,28]. Footnotes: (A) relative frequencies of shock stage classification, %; (B) short-term (in-hospital * or 30-day **) mortality in AMI-CS, %.