24h SCAI stage reclassification to predict outcome. Insights from the prospective Altshock-2 registry

Abstract Background Cardiogenic shock (CS) includes several phenotypes of congestion or hypoperfusion with heterogenous hemodynamic features. Timely prognostication scoring tools is warranted to identify patients requiring escalation mechanical circulatory support (MCS) and avoid futility. Purpose Accordingly, we explored the role updated Society for Cardiovascular Angiography Interventions (SCAI) stages classification on in-hospital mortality using a prospective national registry. Methods The Altshock-2 Registry 237 CS all etiologies enrolled between March 2020 February 2022 in 11 Italian Centers. Patients were classified according admission SCAI (assigned prospectively independently most recently released version); 24-hour re-assessment was performed 201 patients. In-hospital evaluated association 24 hours adjusted relevant clinical covariates. Results Of included, 20 (8.4%) had stage B, 132 (55.8%) C, 60 (25.3) D 25 (10.5%) E. B worst reclassification at 24-hours, 42% them showing worsened status only 8% improving. 38%. revised baseline not associated mortality, whereas 24-h correctly predicted (the rate death 18% 27% 64% D, 100% E). At multivariate analysis (adjusted age, gender, eGFR, inotropic score MCS) evaluation an independent predictor (OR 95% CI were, respectively, 3.32, 0.36–30.63, p=0.290 C 13.07, 1.69–146.3 E perfectly predicting because died). Conclusions may improve evaluation. Aggressive treatment (either pharmacological MCS escalation) should be tailored order achieve prompt improvement within first 24-hours; refractory portends dismal prognosis. Funding Acknowledgement Type funding sources: None.