Abstract
Objective: To investigate the association between SCAI classification and 30-day and 3-month mortality in patients hospitalized for acute decompensated heart failure at the Vietnam National Heart Institute – Bach Mai Hospital. Subjects and methods: A retrospective descriptive study of patients with chronic heart failure admitted for acute decompensation at the Vietnam National Heart Institute – Bach Mai Hospital. Clinical and paraclinical parameters at admission and during hospitalization were collected to assess cardiogenic shock stages according to the SCAI classification. Data on 30-day and 3-month mortality were collected to evaluate all-cause mortality outcomes. Results: A total of 632 patients admitted to the Vietnam National Heart Institute – Bach Mai Hospital between August 2023 and July 2024 were included. At 1 month after admission, 71 patients had died; at 3 months, 15 patients were lost to follow-up and an additional 14 patients had died. Multivariable Cox regression analysis showed that SCAI classification at admission was an independent predictor of 30-day and 3-month mortality, with hazard ratios (HRs) of 3.1 (95% CI: 2.09–4.59; p < 0.001) and 3.4 (95% CI: 2.33–4.98; p < 0.001), respectively. Similarly, SCAI classification after 1 day of hospitalization and progression to SCAI stages C, D, or E at any time during the treatment course were also independent predictors of 30-day and 3-month mortality, with HRs of 4.96 (95% CI: 3.14–7.85; p < 0.001) and 4.26 (95% CI: 2.79–6.50; p < 0.001), and 3.53 (95% CI: 2.71–4.59; p < 0.001) and 3.65 (95% CI: 2.80–4.74; p < 0.001), respectively. Comparison of the areas under the ROC curves of SCAI classification at different time points for mortality prediction showed that progression to SCAI stages C, D, or E during the entire treatment course had a higher prognostic value for mortality than SCAI classification at admission or after 1 day of hospitalization. Conclusion: The SCAI classification proposed by the Society for Cardiovascular Angiography and Interventions is an independent predictor of 30-day and 3-month mortality in patients with acute decompensated heart failure. Assessment of SCAI stages at multiple time points throughout the treatment course provides better prognostic value for mortality.
