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SCAI cardiogenic shock classification after out of hospital cardiac arrest and association with outcome
Author(s) -
Pareek Nilesh,
Dworakowski Rafal,
Webb Ian,
Barash Jemma,
Emezu Gift,
Melikian Narbeh,
Hill Jonathan,
Shah Ajay,
MacCarthy Philip,
Byrne Jonathan
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28984
Subject(s) - medicine , cardiogenic shock , shock (circulatory) , cardiology , clinical endpoint , population , logistic regression , myocardial infarction , randomized controlled trial , environmental health
Objectives We aimed to validate the Society for Cardiovascular Angiography and Interventions (SCAI) classification to evaluate association with outcome in a real‐world population and effect of invasive therapies. Background Cardiogenic shock is common after Out of Hospital Cardiac Arrest (OOHCA) but is often multifactorial and challenging to stratify. Methods The SCAI shock grade was applied to an observational registry of OOHCA patients on admission to our center between 2012 and 2017. The primary end‐point was 30‐day mortality and secondary end‐points were mode of death and 12‐month mortality. Provision of early CAG and mechanical circulatory support (MCS) was evaluated by SCAI shock grade using logistic regression. Results Three hundred and ninety‐three patients (median age 64.3 years (24.9% females) were included. One hundred and seven patients (27.2%) were in Grade A, 94 (23.9%) in Grade B, 66 (16.8%) in Grade C, 91 (23.2%) in Grade D, and 35 (8.9%) in Grade E. There was a step‐wise significant increase in 30‐day mortality with increasing shock grade (A 28.9% vs. B 33.0% vs. C 54.5% vs. D 59.3% vs. E 82.9%; p < .0001). With worsening shock grade, requirement for renal replacement therapy and mortality from multiorgan dysfunction syndrome and cardiogenic causes increased. Early CAG was performed equally in all groups but was significantly associated with reduced mortality in SCAI grade D only (OR 0.26 [CI 0.08–0.91], p = .036). Conclusions Increasing SCAI shock grade after OOHCA is associated with 30‐day mortality, requirement for renal replacement therapy and mortality attributed to multiorgan dysfunction syndrome and cardiac etiology death.