Katherine L Thayer1, Elric Zweck1,2, Mohyee Ayouty3, A Reshad Garan4, Jaime Hernandez-Montfort5, Claudius Mahr6, Kevin J Morine1, Sarah Newman1, Lena Jorde3, Jillian L Haywood1, Neil M Harwani1, Michele L Esposito1, Carlos D Davila1, Detlef Wencker7, Shashank S Sinha8, Esther Vorovich9, Jacob Abraham10, William O'Neill11, James Udelson1, Daniel Burkhoff12, Navin K Kapur1. 1. The CardioVascular Center, Tufts Medical Center, Boston, MA (K.L.T., E.Z., K.J.M., S.N., J.L.H., N.M.H., M.L.E., C.D.D., J.U., N.K.K.). 2. Medical Faculty, Heinrich Heine University, Düsseldorf, Germany (E.Z.). 3. Tufts University School of Medicine, Boston, MA (M.A., L.J.). 4. Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.R.G.). 5. Cleveland Clinic Florida, Department of Cardiovascular Medicine Weston (J.H.-M.). 6. Heart Institute at University of Washington Medical Center, Seattle (C.M.). 7. Baylor Scott & White Advanced Heart Failure Clinic, Dallas, TX (D.W.). 8. Inova Heart and Vascular Institute, Falls Church, VA (S.S.S.). 9. Bluhm Cardiovascular Institute of Northwestern Medicine, Chicago, IL (E.V.). 10. Providence Heart Institute, Portland, OR (J.A.). 11. Center for Structural Heart Disease at Henry Ford Hospital, Detroit, MI (W.O.). 12. Cardiovascular Research Foundation, NY (D.B.).
Abstract
BACKGROUND: Risk stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) stages as an approach to identify patients at risk for in-hospital mortality remains under investigation. We studied the utility of the SCAI stages and further explored the impact of hemodynamic congestion on clinical outcomes. METHODS: The CS Working Group registry includes patients with CS from 8 medical centers enrolled between 2016 and 2019. Patients were classified by the maximum SCAI stage (B-E) reached during their hospital stay according to drug and device utilization. In-hospital mortality was evaluated for association with SCAI stages and hemodynamic congestion. RESULTS: Of the 1414 patients with CS, the majority were due to decompensated heart failure (50%) or myocardial infarction (MI; 35%). In-hospital mortality was 31% for the total cohort, but higher among patients with MI (41% versus 26%, MI versus heart failure, P<0.0001). Risk for in-hospital mortality was associated with increasing SCAI stage (odds ratio [95% CI], 3.25 [2.63-4.02]) in both MI and heart failure cohorts. Hemodynamic data was available in 1116 (79%) patients. Elevated biventricular filling pressures were common among patients with CS, and right atrial pressure was associated with increased mortality and higher SCAI Stage. CONCLUSIONS: Our findings support an association between the proposed SCAI staging system and in-hospital mortality among patient with heart failure and MI. We further identify that venous congestion is common and identifies patients with CS at high risk for in-hospital mortality. These findings provide may inform future management protocols and clinical studies.
BACKGROUND: Risk stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) stages as an approach to identify patients at risk for in-hospital mortality remains under investigation. We studied the utility of the SCAI stages and further explored the impact of hemodynamic congestion on clinical outcomes. METHODS: The CS Working Group registry includes patients with CS from 8 medical centers enrolled between 2016 and 2019. Patients were classified by the maximum SCAI stage (B-E) reached during their hospital stay according to drug and device utilization. In-hospital mortality was evaluated for association with SCAI stages and hemodynamic congestion. RESULTS: Of the 1414 patients with CS, the majority were due to decompensated heart failure (50%) or myocardial infarction (MI; 35%). In-hospital mortality was 31% for the total cohort, but higher among patients with MI (41% versus 26%, MI versus heart failure, P<0.0001). Risk for in-hospital mortality was associated with increasing SCAI stage (odds ratio [95% CI], 3.25 [2.63-4.02]) in both MI and heart failure cohorts. Hemodynamic data was available in 1116 (79%) patients. Elevated biventricular filling pressures were common among patients with CS, and right atrial pressure was associated with increased mortality and higher SCAI Stage. CONCLUSIONS: Our findings support an association between the proposed SCAI staging system and in-hospital mortality among patient with heart failure and MI. We further identify that venous congestion is common and identifies patients with CS at high risk for in-hospital mortality. These findings provide may inform future management protocols and clinical studies.
Authors: Alastair G Proudfoot; Antonis Kalakoutas; Susanna Meade; Mark J D Griffiths; Mir Basir; Francesco Burzotta; Sharon Chih; Eddy Fan; Jonathan Haft; Nasrien Ibrahim; Natalie Kruit; Hoong Sern Lim; David A Morrow; Jun Nakata; Susanna Price; Carolyn Rosner; Robert Roswell; Mark A Samaan; Marc D Samsky; Holger Thiele; Alexander G Truesdell; Sean van Diepen; Michelle Doughty Voeltz; Peter M Irving Journal: Circ Heart Fail Date: 2021-11-22 Impact factor: 8.790
Authors: Ankeet S Bhatt; David D Berg; Erin A Bohula; Carlos L Alviar; Vivian M Baird-Zars; Christopher F Barnett; James A Burke; Anthony P Carnicelli; Sunit-Preet Chaudhry; Lori B Daniels; James C Fang; Christopher B Fordyce; Daniel A Gerber; Jianping Guo; Jacob C Jentzer; Jason N Katz; Norma Keller; Michael C Kontos; Patrick R Lawler; Venu Menon; Thomas S Metkus; Jose Nativi-Nicolau; Nicholas Phreaner; Robert O Roswell; Shashank S Sinha; R Jeffrey Snell; Michael A Solomon; Sean Van Diepen; David A Morrow Journal: J Card Fail Date: 2021-10 Impact factor: 6.592
Authors: Shashank S Sinha; Carolyn M Rosner; Behnam N Tehrani; Aneel Maini; Alexander G Truesdell; Seiyon Ben Lee; Pramita Bagchi; James Cameron; Abdulla A Damluji; Mehul Desai; Shashank S Desai; Kelly C Epps; Christopher deFilippi; M Casey Flanagan; Leonard Genovese; Hala Moukhachen; James J Park; Mitchell A Psotka; Anika Raja; Palak Shah; Matthew W Sherwood; Ramesh Singh; Daniel Tang; Karl D Young; Timothy Welch; Christopher M O'Connor; Wayne B Batchelor Journal: Circ Heart Fail Date: 2022-05-05 Impact factor: 10.447
Authors: Rasha Kaddoura; Amr Elmoheen; Ehab Badawy; Mahmoud F Eltawagny; Mohamed A Seif; Khalid Bashir; Amar M Salam Journal: J Drug Assess Date: 2021-07-20
Authors: Carlos D Davila; Michele Esposito; Colin S Hirst; Kevin Morine; Lena Jorde; Sarah Newman; Vikram Paruchuri; Evan Whitehead; Katherine L Thayer; Navin K Kapur Journal: Front Cardiovasc Med Date: 2021-02-11
Authors: Adamantios Tsangaris; Tamas Alexy; Rajat Kalra; Marinos Kosmopoulos; Andrea Elliott; Jason A Bartos; Demetris Yannopoulos Journal: Front Cardiovasc Med Date: 2021-07-07