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Pareek N, Dworakowski R, Webb I, Barash J, Emezu G, Melikian N, Hill J, Shah A, MacCarthy P, Byrne J. SCAI cardiogenic shock classification after out of hospital cardiac arrest and association with outcome. Catheter Cardiovasc Interv 2020; 97:E288-E297. [PMID: 32445610 DOI: 10.1002/ccd.28984] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Nilesh Pareek
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Rafal Dworakowski
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Ian Webb
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Jemma Barash
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Gift Emezu
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Narbeh Melikian
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Jonathan Hill
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Ajay Shah
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, London, UK
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