The Utility and Validation of SCAI-CSWG Stages in Patients With Acute Myocardial Infarction-Related Cardiogenic Shock
Year: 2024
Type: article
Study design: Observational Study
Abstract: Background Outcomes of patients with acute myocardial infarction–related cardiogenic shock (AMICS) stratified by the Society for Cardiovascular Angiography & Interventions (SCAI) shock stages in the Gulf region are not well known. Methods We analyzed data from patients with AMICS presenting to multiple centers across the Gulf region between January 2020 and December 2022. Patients were grouped according to SCAI-Cardiogenic Shock Working Group classification: group 1 (SCAI shock stages B/C) and group 2 (SCAI shock stages D/E). Primary end points were survival at 6, 12, 18, and 24 months. Both univariate and multivariate statistical methods were employed in the analysis. Results A total of 1513 patients from the Gulf Cardiogenic Shock registry, were included with 31.1% in group 1 and 68.9% in group 2. The median follow-up was 6 months. Survival rates in group 1 were 87%, 72%, 56%, and 48% at 6, 12, 18, and 24 months, respectively, whereas group 2 exhibited survival rates of 66%, 29%, 14%, and 4%, respectively, over the same periods. Survival progressively declined with advancing SCAI shock stages, with stage B having the highest survival rates and stage E the lowest ( P < .001). Multivariable Cox regression analysis identified higher SCAI stages as strong predictors of increased mortality, with patients in group 2 having a more than 3-fold higher risk of mortality compared to those in group 1 (hazard ratio, 3.13; 95% CI, 2.40-4.07; P < .001). Additionally, lower left ventricular ejection fraction, advanced age, and the presence of tachyarrhythmias were associated with increased mortality risk. Conclusions This is the first study to validate SCAI-Cardiogenic Shock Working Group stages in a large cohort of patients with AMICS. The SCAI shock staging classification was significantly associated with higher short- and long-term mortality in this cohort, with patients in more advanced stages (D/E) experiencing markedly worse survival outcomes. These findings underscore the utility of SCAI staging in stratifying long-term risk among AMICS patients in the Gulf region. Identification of cardiogenic shock patients at SCAI stages D and E with early hemodynamic monitoring and treating them aggressively with newer mechanical circulatory support in the early stages may improve patient survival.
Authors: Rajesh Rajan, Mohammed Al Jarallah, Amin Daoulah, Prashanth Panduranga, Ahmed Elmahrouk, Abeer Said Mohamed Al Rawahi, Said Al Maashani, Hatem M. Aloui, Mubarak Abdulhadi Aldossari, Nooraldaem Yousif, Husam A. Noor, Abdulrahman Arabi, Gi Eun Kim, Mohamad Safieh, Wael Almahmeed, Hassan Khan, Mohammed A. Qutub, Mohammed Alshehri, Amr A. Arafat, Omar Kanbr, Alsayed Ali Almarghany, Adnan Fathey Hussien, Amir Lotfi, Mohamed Ajaz Ghani, Badr Alzahrani, Alaa Aldossari, Taher Hassan, Abdullah Alenezi, Waleed Alharbi, Ahmed Jamjoom, Abdulwali Abohasan, Raja Dashti, Peter A. Brady, Ibrahim Al Zakwani, Maheswara Satya Gangadhara Rao Golla, Laura Al Obaid, Abdullah N. AlAwadi
Institutions: Amiri Hospital, King Faisal Specialist Hospital & Research Centre, Tanta University, Royal Hospital, Sultan Qaboos Hospital, King Saud Medical City, Hamad Medical Corporation, Cleveland Clinic Abu Dhabi, King Abdulaziz University, Elrazi University, Al-Azhar University, International Medical Center in Jeddah, Baystate Medical Center, University of Massachusetts Chan Medical School, Baystate Health, King Fahd Medical City, Bugshan Hospital, Chest Diseases Hospital, King Saud University, Advocate Illinois Masonic Medical Center, Sultan Qaboos University
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: gold
Estimated APC paid: $2,400
OpenAlex ID: W4404516899