COMPARISON OF THE PREDICTIVE PERFORMANCE OF CARDIOGENIC SHOCK SCORES IN A REAL-WORLD LATIN AMERICA COUNTRY.

ABSTRACT: Background : Mortality in cardiogenic shock (CS) is up to 40%, and although risk scores have been proposed to stratify and assess mortality in CS, they have been shown to have inconsistent performance. The purpose was to compare CS prognostic scores and describe their performance in a real-world Latin American country. Methods : We included 872 patients with CS. The Society for Cardiovascular Angiography and Interventions (SCAI), CARDSHOCK, IABP-Shock II, Cardiogenic Shock Score, age-lactate-creatinine score, Get-With-The-Guidelines Heart Failure score, and Acute Decompensated Heart Failure National Registry scores were calculated. Decision curve analyses were performed to evaluate the net benefit of the different scoring systems. Logistic and Cox regression analyses were applied to construct area under the curve (AUC) statistics, this last one against time using the Inverse Probability of Censoring Weighting method, for in-hospital mortality prediction. Results: When logistic regression was applied, the scores had a moderate-good performance in the overall cohort that was higher AUC in the CARDSHOCK ( c = 0.666). In acute myocardial infarction-related CS (AMI-CS), CARDSHOCK still is the highest AUC (0.68). In non-AMI-CS only SCAI (0.668), CARDSHOCK (0.533), and IABP-SHOCK II (0.636) had statistically significant values. When analyzed over time, significant differences arose in the AUC, suggesting that a time-sensitive component influenced the prediction of mortality. The highest AUC was for the CARDSHOCK score (0.658), followed by SCAI (0.622). In AMI-CS-related, the highest AUC was for the CARDSHOCK score (0.671). In non-AMI-CS, SCAI was the best (0.642). Conclusions : Clinical scores show a time-sensitive AUC, suggesting that performance could be influenced by time and the type of CS. Understanding the temporal influence on the scores could provide a better prediction and be a valuable tool in CS.

Application of the SCAI classification to admission of patients with cardiogenic shock: Analysis of a tertiary care center in a middle-income country.

AIMS: The Society of Cardiovascular Angiography and Interventions (SCAI) shock stages have been applied and validated in high-income countries with access to advanced therapies. We applied the SCAI scheme at the time of admission in order to improve the risk stratification for 30-day mortality in a retrospective cohort of patients with STEMI in a middle-income country hospital at admission. METHODS: This is a retrospective cohort study, we analyzed 7,143 ST-segment elevation myocardial infarction (STEMI) patients. At admission, patients were stratified by the SCAI shock stages. Multivariate analysis was used to assess the association between SCAI shock stages to 30-day mortality. RESULTS: The distribution of the patients across SCAI shock stages was 82.2%, 9.3%, 1.2%, 1.5%, and 0.8% to A, B, C, D, and E, respectively. Patients with SCAI stages C, D, and E were more likely to have high-risk features. There was a stepwise significant increase in unadjusted 30-day mortality across the SCAI shock stages (6.3%, 8.4%, 62.4%, 75.2% and 88.3% for A, B, C, D and E, respectively; P < 0.0001, C-statistic, 0.64). A trend toward a lower 30-day survival probability was observed in the patients with advanced CS (30.3, 15.4%, and 8.3%, SCAI shock stages C, D, and E, respectively, Log-rank P-value <0.0001). After multivariable adjustment, SCAI shock stages C, D, and E were independently associated with an increased risk of 30-day death (hazard ratio 1.42 [P = 0.02], 2.30 [P<0.0001], and 3.44 [P<0.0001], respectively). CONCLUSION: The SCAI shock stages applied in patients con STEMI at the time of admission, is a useful tool for risk stratification in patients across the full spectrum of CS and is a predictor of 30-day mortality.