Acute Crit Care.  2024 May;39(2):257-265. 10.4266/acc.2023.01620.

Implementation of Society for Cardiovascular Angiography and Interventions classification in patients with cardiogenic shock secondary to acute myocardial infarction in a spanish university hospital

• Cervera JP
• López CAA
• Romero RN
• Macías JC
• Asensio JMN
• Mínguez JRL

• KMID: 2557242
• DOI: http://doi.org/10.4266/acc.2023.01620

Abstract

Background
Killip-Kimball classification has been used for estimating death risk in patients suffering acute myocardial infarction (AMI). Killip-Kimball stage IV corresponds to cardiogenic shock. However, the Society for Cardiovascular Angiography and Interventions (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 AMI” 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%, P=0.03 and P<0.001, respectively). Age >69 years, creatinine >1.15 mg/dl and advanced SCAI stages (SCAI D and E) were independent predictors of 30-day mortality. Mechanical circulatory support use showed an almost significant benefit in advanced SCAI stages (D and E hazard ratio, 0.45; 95% confidence interval, 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. Mechanical circulatory support could play a beneficial role in advanced SCAI stages.

Keyword

AMICS; death risk; Killip; mechanical circulatory support; predictors; SCAI

Figure

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  Figure 1. Patient inclusion flowchart. HF: heart failure; AMICS: acute myocardial infarction cardiogenic shock; SCAI: Society for Cardiovascular Angiography and Interventions.

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  Figure 2. Kaplan-Meier plot showing progressive increase in 30-day mortality rate according to Society for Cardiovascular Angiography and Interventions (SCAI) stage and Killip IV stage.

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  Figure 3. Comparison of 30-day mortality rate estimation between Killip IV stage and Society for Cardiovascular Angiography and Interventions (SCAI) C (A), D (B), and E (C) stages.

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  Figure 4. Kaplan-Meier curves showing impact of mechanical circulatory support (MCS) on survival in advanced Society for Cardiovascular Angiography and Interventions (SCAI) stages. HR: hazard ratio; CI: confidence interval.

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