TORNA ALL’ELENCO

24h SCAI stage reclassification to predict outcome. Insights from the prospective Altshock-2 registry in European Respiratory Journal

2022
ASL Città di Torino

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (15)Vedi tutti...

Morici N
Don Gnocchi Foundation - IRCCS Centro S. Maria Nascente, Milan, Italy
Frea S
Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
Ditali V
Niguarda Ca Granda Hospital, Milan, Italy

et alii...

Abstract

Background: Cardiogenic shock (CS) includes several phenotypes of congestion or hypoperfusion with heterogenous hemodynamic features. Timely prognostication with scoring tools is warranted to identify patients requiring escalation to mechanical circulatory support (MCS) and to avoid futility. Purpose: Accordingly, we explored the role of the updated Society for Cardiovascular Angiography and Interventions (SCAI) stages classification on in-hospital mortality using a prospective national registry. Methods: The Altshock-2 Registry includes 237 patients with CS of all etiologies enrolled between March 2020 and February 2022 in 11 Italian Centers. Patients were classified according to the admission SCAI stages (assigned prospectively and independently updated according to the most recently released version); 24-hour re-assessment was prospectively performed in 201 patients. In-hospital mortality was evaluated for association with admission and 24 hours SCAI stages adjusted for the most relevant clinical covariates. Results: Of the 237 patients included, 20 (8.4%) had SCAI shock stage B, 132 (55.8%) SCAI stage C, 60 (25.3) SCAI stage D and 25 (10.5%) SCAI stage E. Patients in stage B had the worst reclassification at 24- hours, with 42% of them showing worsened status and only 8% improving. In-hospital mortality was 38%. The revised SCAI stages at baseline were not independently associated with in-hospital mortality, whereas the SCAI classification at 24-h correctly and independently predicted mortality (the rate of in-hospital death was 18% for patients in SCAI shock stage B, 27% for SCAI shock stage C, 64% for SCAI shock stage D, 100% for SCAI shock stage E). At the multivariate analysis (adjusted for age, gender, eGFR, inotropic score and MCS) only SCAI classification at 24-hour evaluation was an independent predictor of in-hospital mortality (OR and 95% CI were, respectively, 3.32, 0.36-30.63, p=0.290 for SCAI stage C and 13.07, 1.69- 146.3 for SCAI stage D, w

DOI : 10.1093/eurheartj/ehac544.1501

Keywords

adult; angiography; assisted circulation; cardiogenic shock; conference abstract; controlled study; estimated glomerular filtration rate; female; gender; human; in-hospital mortality; inotropism; major clinical study; male; mortality; multicenter study; prognosis; prospective study;