- Cardiology
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Implementation of Society for Cardiovascular Angiography & Interventions classification in patients with cardiogenic shock secondary to acute myocardial infarction in a spanish university hospital
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Javier Pérez Cervera, Carlos Antonio Aranda López, Rosa Navarro Romero, Javier Corral Macías, Juan Manuel Nogales Asensio, José Ramón López Mínguez
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Received December 19, 2023 Accepted March 6, 2024 Published online April 2, 2024
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DOI: https://doi.org/10.4266/acc.2023.01620
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 Abstract
- Background
The Killip-Kimball classification has been used for estimating death risk in patients suffering acute myocardial infarction. Stage IV of this classification corresponds to cardiogenic shock. However, the ______ (SCAI) classification provides a more precise tool to classify patients according to shock severity. The aim of this study was to apply this classification to a cohort of Killip IV patients and to analyze the differences in death risk estimation between the two classifications.
Methods
A single-center retrospective cohort study of 100 consecutive patients hospitalized for “Killip IV Acute Myocardial Infarction” between 2016 and 2023 was performed to reclassify patients according to SCAI stage.
Results
Distribution of patients according to SCAI stages was: B=4%; C=53%; D=27%, E=16%. Thirty-day mortality increased progressively according to these stages (B=0%; C=11.88%; D=55.56%; E=87.50%; P<0.001). The exclusive use of Killip IV stage overestimated death risk compared to SCAI C (35% vs. 11.88%; P=0.002) and underestimated it compared to SCAI D and E stages (35% vs. 55.56% and 87.50%, respectively; P<0.05 for both). Multivariable Cox regression analysis provided 30-day mortality predictors for _____ (AMICS): age >69 years (hazard ratio [HR], 2.34; 95% CI, 1.15–4.86), creatinine >1.15 mg/dl (HR, 11.52; 95% CI, 1.43–92.77) and advanced SCAI stages (SCAI D: HR, 3.29; 95% CI, 1.20–9.01 and SCAI E: HR, 6.21; 95% CI, 2.28–16.88; all P<0.05). Mechanical circulatory support (MCS) use showed an almost significant benefit in advanced SCAI stages (D and E: HR, 0.45; 95% CI, 0.19–1.06; P=0.058).
Conclusions
SCAI classification showed superior death risk estimation compared to Killip IV. Age, creatinine levels and advanced SCAI stages were independent predictors of 30-day mortality. MCS could play a beneficial role in advanced SCAI stages.
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