The following is the summary of “Clinician and Algorithmic Application of the 2019 and 2022 Society of Cardiovascular Angiography and Intervention Shock Stages in the Critical Care Cardiology Trials Network Registry” published in the December 2022 issue Heart Failure by Patel, et al.
The risk of death from cardiogenic shock can be successfully stratified using an algorithm based on the 2019 Society of Cardiovascular Angiography and Intervention (SCAI) shock phases. The staging of SCAI is subjectively evaluated by clinicians. Additionally, the ramifications of the 2022 SCAI criterion modification still need to be determined. The Critical Care Cardiology Trials Network is a multi-institutional database of critical care units specializing in cardiac care (CICUs).
From 2019-2021, 32 hospitals provided a minimum 2-month window of consecutive medical CICU admissions. 3 distinct staging approaches were used to evaluate in-hospital mortality: physician assessment, Critical Care Cardiology Trials Network algorithmic application of the 2019 SCAI criteria, and a revised Critical Care Cardiology Trials Network application utilizing the 2022 SCAI criteria. Of the 9,612 admissions, 1,340 (13.9%) were diagnosed with cardiogenic shock, and 35.2% of those people died while hospitalized. Clinical and algorithm-based staging with the 2019 SCAI criteria revealed a progressive increase in mortality risk from stage C to stage E (stage C: 19.0% to 83.7% and stage E: 14.6% to 52.2%, respectively) respectively; Ptrend<0.001 for each).
Higher-risk patients were found when clinicians assigned SCAI stages instead of an algorithm (stage D: 49.9% versus 29.3%; stage E: 83.7% versus 52.2%). Mortality for stages C-E ranged from 21.9% to 70.5% (Ptrend<0.001) when the 2022 SCAI criteria were included in the algorithm. A stepwise gradient in mortality risk is identified using either clinician- or algorithm-based application of the 2019 SCAI stages, though higher-risk patients may be better allocated into advanced SCAI stages using clinician staging. By using the vasoactive-inotropic score and the updated SCAI criteria from 2022, researchers may further refine risk categorization through algorithmic staging.