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Criteria for Defining Stages of Cardiogenic Shock Severity
Journal article   Open access   Peer reviewed

Criteria for Defining Stages of Cardiogenic Shock Severity

Navin K. Kapur, Manreet Kanwar, Shashank S. Sinha, Katherine L. Thayer, A. Reshad Garan, Jaime Hernandez-Montfort, Yijing Zhang, Borui Li, Paulina Baca, Fatou Dieng, …
Journal of the American College of Cardiology, v 80(3), pp 185-198
19 Jul 2022
DOI: https://doi.org/10.1016/j.jacc.2022.04.049
PMID: 35835491
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.jacc.2022.04.049View
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Abstract

Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Science & Technology ESI Highly Cited Paper (Incites)
BACKGROUND Risk-stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) staging system for CS severity lacks uniform criteria defining each stage. OBJECTIVES The purpose of this study was to test parameters that define SCAI stages and explore their utility as predictors of in-hospital mortality in CS. METHODS The CS Working Group registry includes patients from 17 hospitals enrolled between 2016 and 2021 and was used to define clinical profiles for CS. We selected parameters of hypotension and hypoperfusion and treatment intensity, confirmed their association with mortality, then defined formal criteria for each stage and tested the association between both baseline and maximum Stage and mortality. RESULTS Of 3,455 patients, CS was caused by heart failure (52%) or myocardial infarction (32%). Mortality was 35% for the total cohort and higher among patients with myocardial infarction, out-of-hospital cardiac arrest, and treatment with increasing numbers of drugs and devices. Systolic blood pressure, lactate level, alanine transaminase level, and systemic pH were significantly associated with mortality and used to define each stage. Using these criteria, baseline and maximum stages were significantly associated with mortality (n = 1,890). Lower baseline stage was associated with a higher incidence of stage escalation and a shorter duration of time to reach maximum stage. CONCLUSIONS We report a novel approach to define SCAI stages and identify a significant association between baseline and maximum stage and mortality. This approach may improve clinical application of the staging system and provides new insight into the trajectory of hospitalized CS patients. (Cardiogenic Shock Working Group Registry [CSWG]; NCT04682483) (C) 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation.

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198 citations in Web of Science
188 citations in Scopus

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Highly Cited Paper 
Collaboration types
Domestic collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
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