Brozzi Nicolas, Napoli Federico, Aleman Rene, Mando Florencia, Estep Jerry D, Sheffield Cedric D, Navia Jose L, Velez Mauricio, Snipelisky David, Rivera Nina Thakkar, Baran David A
Department of Cardio-Thoracic Surgery at Heart, Thoracic & Vascular Institute at Cleveland Clinic Florida, Weston, Florida, USA.
Department of Cardiology at Heart, Thoracic & Vascular Institute at Cleveland Clinic Florida, Weston, Florida, USA.
JACC Adv. 2025 Jul 10;4(8):101975. doi: 10.1016/j.jacadv.2025.101975.
Risk prognostication is essential to identify patients at risk of higher mortality following cardiac surgery.
The Society for Cardiac Angiography and Intervention (SCAI) shock construct was adapted to cardiac surgical patients to create the CS-SCAI staging and it was applied at various time points and correlated with survival.
Retrospective analysis of Society of Thoracic Surgeons adult cardiac surgery database from January 2015 to December 2019. The focus was 30-day survival and multivariate logistic analysis was used to examine factors. CS-SCAI E indicates extracorporeal life support or biventricular devices, CS-SCAI D patients receive vasoactive(s) and a single device whereas CS-SCAI C patients have either one device or a vasoactive but not both. CS-SCAI B has heart failure, urgent surgery, or cardiopulmonary resuscitation, otherwise CS-SCAI A is assigned.
A total of 1,164,015 patients were included. Preoperatively 35.9%, 54.9%, 8.3%, 0.7%, and 0.2% of patients were in Stages A, B, C, D, and E, respectively, with corresponding mortality of 1.2%, 2.12%, 9.84%, 17.06%, and 42.1% (chi-square P < 0.0001). In the preoperative and postoperative setting, CS-SCAI stage was the strongest predictor of mortality. Transition to worsened CS-SCAI stage postoperatively occurred in 6,508 patients with 30-day mortality 51.6%. The strongest predictors of stage transition were cardiopulmonary bypass time, preoperative CS-SCAI stage, and aortic cross clamp time.
CS-SCAI facilitates risk prognostication prior to and following cardiac surgery. Transitions of stage are associated with a spectrum of high mortality and could be used to better define post-cardiotomy shock.
风险预后对于识别心脏手术后有较高死亡风险的患者至关重要。
将心脏血管造影和介入学会（SCAI）休克分类法应用于心脏手术患者，创建CS-SCAI分期，并在不同时间点应用，与生存率相关联。
对2015年1月至2019年12月胸外科医师协会成人心脏手术数据库进行回顾性分析。重点是30天生存率，并使用多因素逻辑回归分析来检查相关因素。CS-SCAI E表示体外生命支持或双心室装置，CS-SCAI D患者接受血管活性药物和单一装置，而CS-SCAI C患者有一个装置或血管活性药物但不是两者都有。CS-SCAI B有心力衰竭、急诊手术或心肺复苏，否则归为CS-SCAI A。
共纳入116401名患者。术前分别有35.9%、54.9%、8.3%、0.7%和0.2%的患者处于A、B、C、D和E期，相应死亡率分别为1.2%、2.12%、9.84%、17.06%和42.1%（卡方检验P<0.0001）。在术前和术后情况下，CS-SCAI分期是死亡率的最强预测因素。术后6508例患者出现CS-SCAI分期恶化，30天死亡率为51.6%。分期转变的最强预测因素是体外循环时间、术前CS-SCAI分期和主动脉阻断时间。
CS-SCAI有助于心脏手术前后的风险预后。分期转变与一系列高死亡率相关，可用于更好地定义心脏术后休克。
