Author + information
- Received May 22, 2019
- Revision received July 5, 2019
- Accepted July 7, 2019
- Published online September 20, 2019.
- Jacob C. Jentzer, MDa,b,∗ (, )@davebaran,
- Sean van Diepen, MD, MScc,
- Gregory W. Barsness, MDa,
- Timothy D. Henry, MDd,
- Venu Menon, MDe,
- Charanjit S. Rihal, MD, MBAa,
- Srihari S. Naidu, MDf and
- David A. Baran, MDg
- aDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- cDepartment of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
- dCarl and Edyth Lindner Center for Research and Education, Christ Hospital Health Network, Cincinnati, Ohio
- eDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- fWestchester Heart and Vascular Institute, Westchester Medical Center and New York Medical College, Valhalla, New York
- gSentara Heart Hospital, Advanced Heart Failure Center and Eastern Virginia Medical School, Norfolk, Virginia
- ↵∗Address for correspondence:
Dr. Jacob C. Jentzer, Department of Cardiovascular Medicine and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Background A new 5-stage cardiogenic shock (CS) classification scheme was recently proposed by the Society for Cardiovascular Angiography and Intervention (SCAI) for the purpose of risk stratification.
Objectives This study sought to apply the SCAI shock classification in a cardiac intensive care unit (CICU) population.
Methods The study retrospectively analyzed Mayo Clinic CICU patients admitted between 2007 and 2015. SCAI CS stages A through E were classified retrospectively using CICU admission data based on the presence of hypotension or tachycardia, hypoperfusion, deterioration, and refractory shock. Hospital mortality in each SCAI shock stage was stratified by cardiac arrest (CA).
Results Among the 10,004 unique patients, 43.1% had acute coronary syndrome, 46.1% had heart failure, and 12.1% had CA. The proportion of patients in SCAI CS stages A through E was 46.0%, 30.0%, 15.7%, 7.3%, and 1.0% and unadjusted hospital mortality in these stages was 3.0%, 7.1%, 12.4%, 40.4%, and 67.0% (p < 0.001), respectively. After multivariable adjustment, each higher SCAI shock stage was associated with increased hospital mortality (adjusted odds ratio: 1.53 to 6.80; all p < 0.001) compared with SCAI shock stage A, as was CA (adjusted odds ratio: 3.99; 95% confidence interval: 3.27 to 4.86; p < 0.001). Results were consistent in the subset of patients with acute coronary syndrome or heart failure.
Conclusions When assessed at the time of CICU admission, the SCAI CS classification, including presence or absence of CA, provided robust hospital mortality risk stratification. This classification system could be implemented as a clinical and research tool to identify, communicate, and predict the risk of death in patients with, and at risk for, CS.
Dr. Baran has served as a consultant for Abiomed, Abbott, Getinge, and LivaNova; and has served as a speaker for Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 22, 2019.
- Revision received July 5, 2019.
- Accepted July 7, 2019.
- 2019 American College of Cardiology Foundation
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