Coronary Care Unit, National Institute of Cardiology in Mexico City, Mexico City, Mexico.
Department of Interventional Cardiology, National Institute of Cardiology in Mexico City, Mexico City, Mexico.
PLoS One. 2022 Aug 16;17(8):e0273086. doi: 10.1371/journal.pone.0273086. eCollection 2022.
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.
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.
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).
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.
心血管血管造影和介入学会（SCAI）休克分期已在能够获得先进治疗方法的高收入国家得到应用和验证。我们在入院时采用 SCAI 方案，以便对中低收入国家医院的 ST 段抬高型心肌梗死（STEMI）患者进行入院时的 30 天死亡率进行风险分层。
这是一项回顾性队列研究，共分析了 7143 例 ST 段抬高型心肌梗死（STEMI）患者。入院时，患者按 SCAI 休克分期分层。采用多变量分析评估 SCAI 休克分期与 30 天死亡率之间的关系。
患者在 SCAI 休克分期中的分布分别为 A、B、C、D 和 E 期的 82.2%、9.3%、1.2%、1.5%和 0.8%。SCAI 分期为 C、D 和 E 的患者更有可能具有高危特征。未经调整的 30 天死亡率随着 SCAI 休克分期的增加而呈阶梯式显著增加（A、B、C、D 和 E 期分别为 6.3%、8.4%、62.4%、75.2%和 88.3%；P<0.0001，C 统计量，0.64）。在接受先进心脏支持（CS）治疗的患者中，30 天生存率呈下降趋势（SCAI 休克分期 C、D 和 E 期分别为 30.3%、15.4%和 8.3%，对数秩检验 P 值<0.0001）。多变量调整后，SCAI 休克分期 C、D 和 E 与 30 天死亡风险增加独立相关（危险比 1.42[P=0.02]、2.30[P<0.0001]和 3.44[P<0.0001]）。
在 STEMI 患者入院时应用 SCAI 休克分期是对接受全谱 CS 治疗的患者进行风险分层的有用工具，是 30 天死亡率的预测因子。
