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Published on: June 12, 2021
Shock-index as a novel predictor of long-term outcome following primary percutaneous coronary intervention
Ioakim Spyridopoulos1, Awsan Noman2, Javed M Ahmed2
1Freeman Hospital, Newcastle Upon Tyne, UK Institute of Genetic Medicine, Newcastle University, UK.
Insights
The shock index effectively predicts mortality in elderly patients after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). This simple ratio aids in identifying high-risk individuals for targeted treatment strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Early identification of high-risk patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) is crucial for implementing aggressive treatment strategies.
- The shock index, a ratio of heart rate to systolic blood pressure, is a simple yet potentially powerful tool for risk stratification.
Purpose of the Study:
- To evaluate the efficacy of the shock index as a predictor of mortality following PPCI in STEMI patients.
- To compare the predictive value of the shock index with other established parameters for both in-hospital and long-term outcomes.
Main Methods:
- Prospective analysis of 3049 STEMI patients treated with PPCI.
- Stratification of patients into younger (≤75 years) and elderly (>75 years) groups.
- Assessment of in-hospital and long-term mortality predictors, including the shock index, cardiogenic shock, and post-PCI flow.
Main Results:
- Elderly patients exhibited a four-fold higher in-hospital mortality rate compared to younger patients (11.5% vs 2.8%).
- Independent predictors of in-hospital mortality included cardiogenic shock, non-TIMI3 flow post-PCI, age over 75, and a positive shock index.
- For long-term outcomes, previous angina and cerebrovascular events predicted adverse outcomes in younger patients, while previous myocardial infarction and a positive shock index were significant in the elderly.
Conclusions:
- While in-hospital mortality is higher in the elderly post-PPCI, rates remain acceptable.
- The invasively measured shock index before PPCI is the strongest independent predictor of long-term outcomes in elderly patients.
- Predictors for in-hospital mortality were consistent across age groups, but differed significantly for longer-term mortality.
Unlabelled:
Early identification of higher risk patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI) will allow a more aggressive strategy and approach. The aim of this study was to evaluate the shock index (ratio of heart rate/systolic blood pressure on admission) as a predictor of mortality post PPCI in addition to other parameters.
Methods:
We analysed prospectively collected data on 3049 STEMI patients treated with PPCI in a large tertiary centre between March 2008-December 2011, out of which 2424 patients were aged up to 75 years (young) and 625 patients were older than 75 years (elderly).
Results:
Compared to younger patients, in-hospital mortality rates were four-fold higher in the elderly (11.5% vs 2.8%, odds ratio (OR) 3.5, 95% confidence interval (CI) 2.0-5.9). Cardiogenic shock (OR 8.7 (5.1-14.6)), non-TIMI3 (Thrombosis In Myocardial Infarction) flow post percutaneous coronary intervention (PCI) (OR 5.0 (3.1-7.9)), age over 75 (OR 3.5 (2.3-5.3)) and a positive shock index pre PPCI (OR 3.5 (2.0-5.9)) were the strongest independent predictors of in-hospital mortality. For long-term outcome (median follow-up period 454 days) we excluded 141 (4.6%) patients that died during the initial hospital stay. Previous angina (hazard ratio (HR) 2.9), and previous cerebrovascular events (HR 3.7) were predictors of adverse outcome in the younger patients, while previous myocardial infarction (HR 2.0) and a positive shock index (HR 2.3) were predictors in the elderly. Cardiogenic shock prior to PPCI was not able to predict long-term outcome for in-hospital survivors.
Conclusion:
Mortality rates following PPCI were higher in elderly patients although remained acceptable. Invasively measured shock index before PPCI is the strongest independent predictor of long-term outcome in elderly patients. In addition, predictors of in-hospital mortality were similar across different age groups but differed significantly in relation to longer-term mortality.
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