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Randomized Controlled Trial
. 2025 Jan 7;14(1):e036659.
doi: 10.1161/JAHA.124.036659. Epub 2024 Dec 20.

Hemodynamic Characteristics and Prognostic Implication of Modified Society for Cardiovascular Angiography and Interventions Shock Classification in Comatose Patients With Out-of-Hospital Cardiac Arrest

Louise Linde  1   2 , Rasmus P Beske  3 , Martin A S Meyer  3 , Simon Mølstrøm  4 , Johannes Grand  3 , Ole K L Helgestad  1 , Hanne B Ravn  2   4 , Henrik Schmidt  4 , Jesper Kjærgaard  3 , Christian Hassager  3 , Jacob E Møller  1   2   3
Affiliations
Randomized Controlled Trial

Hemodynamic Characteristics and Prognostic Implication of Modified Society for Cardiovascular Angiography and Interventions Shock Classification in Comatose Patients With Out-of-Hospital Cardiac Arrest

Louise Linde et al. J Am Heart Assoc. .

Abstract

Background: Cardiogenic shock complicating acute myocardial infarction is associated with a high mortality rate. Cardiogenic shock after out-of-hospital cardiac arrest (OHCA) can be due to transient myocardial stunning but also reflect the increasing severity of ongoing heart failure. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a division of cardiogenic shock into 5 phenotypes, with cardiac arrest being a modifier. The objective was to apply SCAI shock classification to a well-characterized OHCA population and describe the hemodynamic characteristics and prognostic significance of increasing SCAI classes.

Methods and results: This is a post hoc analysis of data from the BOX (Blood Pressure and Oxygenation Targets in Post Resuscitation Care) trial of comatose patients with OHCA. Patients were classified according to SCAI class upon hospital admission. Invasive arterial and pulmonary arterial measurements were obtained the first 72 hours after admission, and perfusion pressure, cardiac index and cardiac power output were calculated. Of 789 patients included, 31.6% were classified as SCAI class B/C, 29.9% as SCAI class D, and 38.5% as SCAI class E. The first recorded perfusion pressure differed between SCAI class B/C, D, and E being lower in higher SCAI classes. The difference was found only at the first measurement. Cardiac index and cardiac power output did not differ at any time point between classes. The 1-year mortality rate increased with SCAI Class B/C to E (21.3%, 34.3%, and 48.4%, respectively; P<0.001).

Conclusions: The 1-year mortality rate after OHCA increased with increasing SCAI classes, but cardiac index, cardiac power output, and perfusion pressure remained notably similar in the first 72 hours after admission. This challenges whether all OHCAs should be recorded as SCAI class E by default.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.

Keywords: cardiogenic shock; death; hemodynamics; out‐of‐hospital cardiac arrest.

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Conflict of interest statement

Dr Hassager reports research grants from the Lundbeck Foundation, the Novo Nordisk Foundation, and the Danish Heart Foundation; and speakers honorarium from Abiomed and BD. Dr Møller reports institutional research grants from the Novo Nordisk Foundation and Abiomed; travel support for scientific meeting from Abiomed; and speakers fee from Abbott and Boehringer Ingelheim. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Definition of the modified SCAI shock classification used in the present study and occurrence of the parameters in each group on admission to the hospital.
Created with BioRender.com. ALT indicates alanine aminotransferase; MAP, mean arterial blood pressure; SBP, systolic blood pressure; and SCAI, The Society for Cardiovascular Angiography and Interventions. Data from Kapur et al.
Figure 2
Figure 2. Kaplan–Meier curves at 1 year after admission for the 789 patients stratified according to SCAI class.
The P value shown is the overall comparison of the 3 groups. SCAI indicates Society for Cardiovascular Angiography and Interventions.
Figure 3
Figure 3. Hemodynamic measurements within the first 72 hours according to SCAI class.
SCAI indicates Society for Cardiovascular Angiography and Interventions.
Figure 4
Figure 4. Acute kidney injury assessed by KDIGO classification in each SCAI class and the percentages of patients receiving CRRT in each SCAI class.
*The P value shown is the overall comparison between the groups. AKI indicates acute kidney injury; CRRT, continuous renal replacement therapy; KDIGO, Kidney Disease: Improving Global Outcomes; and SCAI, Society for Cardiovascular Angiography and Interventions.
See this image and copyright information in PMC

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