Journal of cardiac failure · 2026
Automated SCAI Staging as a Novel Decision Aid in Cardiogenic Shock Management.
СтатьяНазвание и аннотация: Перевод в очереди
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Saha Amit, Shah Rohan, Beaini Hadi, Lopez Carmen, Xie Donglu, Hall Eric J, Hall Hurst M, Hardin E Ashley, Glazer Craig S, Willett Duwayne L, DAS Sandeep R, Thibodeau Jennifer T, Farr Maryjane A
Аннотация
BACKGROUND: Early serial staging of cardiogenic shock (CS) using the Society for Cardiovascular Angiography and Interventions (SCAI) system has prognostic value in retrospective data. The utility of automated SCAI staging as a decision-support tool has not been described.
OBJECTIVES: We aimed to develop an automated, electronic medical record (EMR)-integrated CS staging tool and to assess providers' use of the tool and the associated practice changes.
METHODS: The 2022 CS Working Group-modified SCAI criteria were translated into an EMR-based score, which automatically stages CS patients every 6 hours. We compared patients' characteristics, SCAI-stage documentation, and CS management before (10/12/22-02/06/24; n = 239) and after (02/07-09/30/24; n = 142) automated staging.
RESULTS: Median age across hospital encounters (n = 381) was 63 years, and 33.6% were women. Heart failure (63.8%) and acute myocardial infarction (14.2%) were the most common CS etiologies. SCAI stage was documented at least once in the Cardiac Intensive Care Unit in 13.0% of preintervention encounters compared with 50.0% following automation (P <0.001). There was a strong time-dependent association between implementing automated staging and increased SCAI stage documentation (P = 0.006). CS surveillance at 72 hours using serial lactate and alanine aminotransferase (ALT) levels also increased from 16.3% to 33.8% and from 17.6% to 26.1% (P < 0.001 for both). In-hospital mortality was 26.0%. Within the automated cohort, 24-hour SCAI stage was associated with likelihood of myocardial recovery (P = 0.001), heart-replacement therapies (P = 0.008), and death (P = 0.067).
CONCLUSIONS: Early, serial, automated staging may provide prognostic value to facilitate CS management.
OBJECTIVES: We aimed to develop an automated, electronic medical record (EMR)-integrated CS staging tool and to assess providers' use of the tool and the associated practice changes.
METHODS: The 2022 CS Working Group-modified SCAI criteria were translated into an EMR-based score, which automatically stages CS patients every 6 hours. We compared patients' characteristics, SCAI-stage documentation, and CS management before (10/12/22-02/06/24; n = 239) and after (02/07-09/30/24; n = 142) automated staging.
RESULTS: Median age across hospital encounters (n = 381) was 63 years, and 33.6% were women. Heart failure (63.8%) and acute myocardial infarction (14.2%) were the most common CS etiologies. SCAI stage was documented at least once in the Cardiac Intensive Care Unit in 13.0% of preintervention encounters compared with 50.0% following automation (P <0.001). There was a strong time-dependent association between implementing automated staging and increased SCAI stage documentation (P = 0.006). CS surveillance at 72 hours using serial lactate and alanine aminotransferase (ALT) levels also increased from 16.3% to 33.8% and from 17.6% to 26.1% (P < 0.001 for both). In-hospital mortality was 26.0%. Within the automated cohort, 24-hour SCAI stage was associated with likelihood of myocardial recovery (P = 0.001), heart-replacement therapies (P = 0.008), and death (P = 0.067).
CONCLUSIONS: Early, serial, automated staging may provide prognostic value to facilitate CS management.