A simplified risk stratification model based on the cardiogenic shock (CS) classification system from the Society for Cardiovascular Angiography and Intervention (SCAI) effectively predicts in-hospital mortality in postcardiotomy (PC) patients, according to a retrospective, observational study published March 18 in JACC: Asia.

Yiwen Wang, MD, et al., analyzed data from 8,335 patients who had cardiac surgery in 2022 and were admitted to Beijing Anzhen Hospital's Center for Cardiac Intensive Care in China for PC treatment (mean age, 59 years; 30% women). To determine the prediction of outcomes in this population, the investigators assessed the parameters that define the stages of CS and the diagnostic utility of the SCAI-based CS classification system. They stratified patients into five stages from mild to severe (stages A-E) based on lactate level and type of intervention received, including vasopressors and mechanical circulatory support systems.

Results showed that CS occurred in 11.1% of postcardiotomy patients. A significant difference in frequency of CS was seen across the stages: stage A ("at-risk"), 57.0%; stage B, 31.9%; stage C, 9.3%, stage D, 0.8% and stage E ("extreme"),1.0% of patients.

The primary outcome of in-hospital mortality occurred in 1.1% of PC patients, and its occurrence increased across the stages of disease: stage A, 0.4%; stage B, 0.8%; stage C, 2.8%; stage D, 7.8%; and stage E, 31.0% (p<0.001).

Notably, the PC-SCAI-based classification scheme demonstrated superior risk stratification vs. traditional risk scores (area under the receiver-operating characteristic curve 0.781 vs. 0.741 for EuroSCORE II and 0.739 for IABP-SHOCK II).

In an accompanying editorial comment, Kitae Kim, MD, PhD, and Joon Bum Kim, MD, PhD, emphasize that "by incorporating hemodynamic and metabolic parameters, the study underscores SCAI staging's prognostic utility and its role in guiding early intervention." Moreover, while "further refinement, external validation, and procedural stratification are needed to optimize its use," they believe that in the future, "integrating SCAI staging into postoperative care could enhance decision-making and improve outcomes" in these patients.