Invasive Hemodynamic Assessment and Classification of In-Hospital Mortality Risk Among Patients With Cardiogenic Shock. (September 2020)

• Record Type: Journal Article
• Authors: Thayer, Katherine L.; Zweck, Elric; Ayouty, Mohyee; Garan, A. Reshad; Hernandez-Montfort, Jaime; Mahr, Claudius; Morine, Kevin J.; Newman, Sarah; Jorde, Lena; Haywood, Jillian L.; Harwani, Neil M.; Esposito, Michele L.; Davila, Carlos D.; Wencker, Detlef; Sinha, Shashank S.; Vorovich, Esther; Abraham, Jacob; O'Neill, William; Udelson, James; Burkhoff, Daniel; Kapur, Navin K.
• Is Part Of: Circulation. Volume 13:Number 9(2020)
• Publication Date: 2020-09
• Subjects: cardiogenic shock -- heart failure -- hemodynamics -- hospital mortality -- myocardial infarction -- right atrial pressure -- ventricular congestion; Heart failure -- Periodicals; 616.129005
• DOI: 10.1161/CIRCHEARTFAILURE.120.007099
• Languages: English
• ISSNs: 1941-3289

Abstract

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. Abstract : Supplemental Digital Content is available in the text.