Abstract 13189: Early Evolution of SCAI-Shock Stage and In-Hospital Mortality in a CICU Population From the Critical Care Cardiology Trials Network-CCCTN

Abstract

Introduction: The SCAI shock staging system is a useful tool for categorizing cardiogenic shock (CS) severity. Presenting SCAI shock stage is known to be associated with in-hospital mortality. However, few studies have evaluated the prognostic significance of very early evolution in SCAI stage. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter network of tertiary CICUs in the US and Canada coordinated by the TIMI Study Group (Boston, MA). Among consecutive CICU admissions with CS, we captured clinician assigned SCAI shock stage at 0-6 hours and 6-12 hours post-CICU admission. Cases were classified as having an improved (e.g., D to C), stable, or worsened SCAI stage between these time periods. The association between change in SCAI stage and in-hospital mortality was evaluated using logistic regression, adjusting for age and 0-6 hour SCAI stage. Results: Among 793 CS admissions between 10/2021 to 09/2022, 73% had a stable SCAI stage, 13% had an early worsening SCAI stage, and 14% had an improving SCAI stage during the initial 12 hours of CICU admission. Compared to cases with stable SCAI stage, cases with worsened SCAI stage had greater use of renal replacement therapy and mechanical circulatory support (Fig 1A) and a longer hospital stay (median 27.5 [IQR 13.6-36.7] vs. 14.7 [8.6-24.9] days, p=0.006). In-hospital mortality among cases with a worsened SCAI stage was 61%, compared to 31% with stable and 26% with improved SCAI stage (Fig 1B). Classification by both initial and 12h SCAI stage revealed a gradient of mortality risk (Fig 1C). Compared to cases with stable SCAI stage, those with worsened SCAI stage had higher adjusted risk of in-hospital mortality (OR: 5.1[95% CI 3.1-8.3]). Conclusion: Patients with early worsening of SCAI stage have a markedly higher risk of in-hospital mortality than those with a stable SCAI stage. The prognostic implication of early evolution in SCAI stage in patients with CS adds to that of SCAI stage on CICU presentation.