Predictive value of the cardiogenic shock working group-modified SCAI criteria in early-stage heart failure-related cardiogenic shock

Background

The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) has been validated in patients with cardiogenic shock (CS) related to heart failure (HF). Its prognostic value in patients with early-stage HF-CS has been scarcely investigated.

Methods

In 208 patients with HF-CS, the relationship between the CSWG-SCAI stage at diagnosis, at 24 and 48 h, the maximum CSWG-SCAI stage, and in-hospital mortality were assessed. In addition, the added value of urine output (UO) to the CSWG-SCAI was evaluated.

Results

At HF-CS diagnosis, stages A and B were most prevalent (33 % and 36 %), while stage C dominated at 24 h (51 %), 48 h (44 %) and maximum CSWG-SCAI (37 %). In total, 87 (42 %) patients died during hospitalization. At HF-CS diagnosis, lower stages (A/B) showed similar prognostic value compared to more severe stages (C/D/E) (p = 0.994). The CSWG-SCAI was associated with in-hospital mortality at 24 h (p = 0.005), 48 h (p = 0.005) and at maximum CSWG SCAI (p < 0.001). Stage deterioration after 24 h was associated with mortality (deteriorated vs. improved: p < 0.001). SCAI-UO showed modest additive predictive value at 48 h (AUC 0.67 vs. AUC 0.70; p = 0.015) and maximum SCAI compared to CSWG-SCAI (AUC 0.66 vs. AUC 0.69; p = 0.032).

Conclusions

At the time of HF-CS diagnosis, the CSWG-SCAI classification failed to predict in-hospital mortality, suggesting that it may not adequately capture the severity of early-stage HF-CS. The CSWG-SCAI classification was associated with in-hospital mortality at 24 and 48 h and at maximum CSWG-SCAI. Incorporating UO into the CSWG-SCAI criteria minimally improved risk stratification.