Vasoactive Intensity Predicts Mortality Beyond SCAI Staging in Cardiogenic Shock
Abstract
Aims Cardiogenic shock (CS) remains associated with high mortality. Severity is traditionally stratified by the Society for Cardiovascular Angiography and Interventions (SCAI) staging system despite substantial heterogeneity within stages. Whether vasoactive therapy intensity or combination provides additional prognostic information beyond SCAI staging remains unknown. This study assessed whether vasoactive support intensity, quantified by the vasoactive–inotropic score (VIS), improves mortality prediction beyond SCAI staging. Methods and results In this retrospective bicentric cohort, consecutive adults admitted for CS between 2018 and 2023 were included. The VIS was calculated. The primary outcome was 90-day mortality. Multivariable logistic regression models adjusted for baseline severity assessed interactions with SCAI stage and the incremental prognostic value of VIS using nested models. Among 1167 patients, 90-day mortality increased across SCAI stages C, D, and E (20.1%, 27.4%, and 45.6%; P < 0.001, respectively), with substantial heterogeneity within stages. In stage C, dobutamine alone was associated with lower mortality than norepinephrine alone [OR = 0.25 (0.09–0.74); P = 0.009]; in stage E, dobutamine plus norepinephrine was associated with higher mortality [OR = 2.39 (1.07–5.36); P = 0.028]. The number of vasoactive agents was associated with mortality (OR = 1.27 per additional agent; P = 0.041) but proved a crude marker, providing only marginal incremental discrimination (R2 = 0.233; Δ = +0.011), with its prognostic information fully captured by VIS (R2 = 0.286 vs. 0.287 with and without number of agents). Adding SCAI stage minimally improved discrimination (R2 = 0.222–0.226; Δ = +0.004), whereas VIS substantially improved model performance (R2 = 0.286; Δ = +0.060; P < 0.001). Conclusion Vasoactive intensity quantified by the VIS improved 90-day mortality prediction beyond SCAI staging and the simple count of vasoactive drugs, providing incremental prognostic information beyond SCAI staging.
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BibTeX
@article{beyls2026vasoactive,
title = {{Vasoactive Intensity Predicts Mortality Beyond SCAI Staging in Cardiogenic Shock}},
author = {Christophe Beyls and Nicolas Mollet and Nathan Helstroffer and Osama Abou-Arab and Yazine Mahjoub and Bélaïd Bouhemad and François Roubille and Guinot Pierre-Grégoire},
journal = {European Heart Journal Open},
year = {2026},
month = aug,
doi = {10.1093/ehjopen/oeag126},
url = {https://u-picardie.hal.science/hal-05722592v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Vasoactive Intensity Predicts Mortality Beyond SCAI Staging in Cardiogenic Shock
AU - Christophe Beyls
AU - Nicolas Mollet
AU - Nathan Helstroffer
AU - Osama Abou-Arab
AU - Yazine Mahjoub
AU - Bélaïd Bouhemad
AU - François Roubille
AU - Guinot Pierre-Grégoire
PY - 2026
DA - 2026/08/18
JO - European Heart Journal Open
DO - 10.1093/ehjopen/oeag126
UR - https://u-picardie.hal.science/hal-05722592v1
AB - Aims Cardiogenic shock (CS) remains associated with high mortality. Severity is traditionally stratified by the Society for Cardiovascular Angiography and Interventions (SCAI) staging system despite substantial heterogeneity within stages. Whether vasoactive therapy intensity or combination provides additional prognostic information beyond SCAI staging remains unknown. This study assessed whether vasoactive support intensity, quantified by the vasoactive–inotropic score (VIS), improves mortality prediction beyond SCAI staging. Methods and results In this retrospective bicentric cohort, consecutive adults admitted for CS between 2018 and 2023 were included. The VIS was calculated. The primary outcome was 90-day mortality. Multivariable logistic regression models adjusted for baseline severity assessed interactions with SCAI stage and the incremental prognostic value of VIS using nested models. Among 1167 patients, 90-day mortality increased across SCAI stages C, D, and E (20.1%, 27.4%, and 45.6%; P < 0.001, respectively), with substantial heterogeneity within stages. In stage C, dobutamine alone was associated with lower mortality than norepinephrine alone [OR = 0.25 (0.09–0.74); P = 0.009]; in stage E, dobutamine plus norepinephrine was associated with higher mortality [OR = 2.39 (1.07–5.36); P = 0.028]. The number of vasoactive agents was associated with mortality (OR = 1.27 per additional agent; P = 0.041) but proved a crude marker, providing only marginal incremental discrimination (R2 = 0.233; Δ = +0.011), with its prognostic information fully captured by VIS (R2 = 0.286 vs. 0.287 with and without number of agents). Adding SCAI stage minimally improved discrimination (R2 = 0.222–0.226; Δ = +0.004), whereas VIS substantially improved model performance (R2 = 0.286; Δ = +0.060; P < 0.001). Conclusion Vasoactive intensity quantified by the VIS improved 90-day mortality prediction beyond SCAI staging and the simple count of vasoactive drugs, providing incremental prognostic information beyond SCAI staging.
SN - 2752-4191
ER -