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Published on: June 12, 2021
Shock Index More Sensitive Than Cardiogenic Shock in ST-Elevation Myocardial Infarction Treated by Primary
Veemal V Hemradj1, Jan Paul Ottervanger, Menko Jan de Boer
1Department of Cardiology, Isala Heart Centre.
Insights
Shock index (SI) is a more sensitive predictor of mortality in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) than cardiogenic shock (CS). SI identifies more at-risk patients, improving risk stratification.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Prognostics
Background:
- Cardiogenic shock (CS) is a known mortality predictor in ST-elevation myocardial infarction (STEMI).
- Shock index (SI), calculated from blood pressure and heart rate, may offer improved predictive power.
- The study investigates the independent prognostic value of SI versus CS in STEMI patients receiving primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To compare the independent impact of SI and CS on 30-day and 1-year mortality.
- To determine if SI is a more sensitive predictor than CS in STEMI patients treated with primary PCI.
Main Methods:
- Analysis of 7,412 consecutive STEMI patients treated with primary PCI.
- Receiver operating characteristic (ROC) curve analysis to determine the optimal SI cut-off value.
- Assessment of the predictive value of SI (cut-off 0.7) and CS for 1-year mortality using adjusted hazard ratios.
Main Results:
- The optimal SI cut-off was 0.7, with an ROC AUC of 0.66, outperforming CS (ROC AUC 0.60, P<0.001).
- At admission, 5.2% of patients had CS and 21.1% had SI ≥0.7.
- Adjusted hazard ratios for 1-year mortality were 2.3 for SI ≥0.7 and 3.1 for CS.
Conclusions:
- SI is a more sensitive prognostic predictor than CS in STEMI patients undergoing primary PCI.
- SI identifies a larger proportion of patients at increased risk of mortality.
- The findings support the use of SI for enhanced risk stratification in STEMI management.
Background:
Cardiogenic shock (CS) is a strong predictor of mortality in patients with ST-elevation myocardial infarction (STEMI), but there is evidence that shock index (SI), taking into account both blood pressure and heart rate, is a more sensitive and powerful predictor. We investigated the independent impact of SI and CS on 30-day and 1-year mortality in patients with STEMI, treated by primary percutaneous coronary intervention (PCI).
Methods And Results:
In 7,412 consecutive patients with STEMI treated with primary PCI, the predictive value of either SI or CS on 1-year mortality was assessed. Best cut-off value of SI, determined using receiver operating characteristic (ROC) curve, was 0.7, with an ROC AUC of 0.66 (95% CI: 0.65-0.67), compared with an ROC AUC of 0.60 (95% CI: 0.59-0.61) for CS (P<0.001). At admission, 387 patients (5.2%) had CS and 1,567 patients (21.1%) had SI ≥0.7. The adjusted hazard ratio of mortality in patients with SI ≥0.7 and in CS patients was, respectively, 3.3 (95% CI: 2.4-4.6) and 3.1 (95% CI: 2.1-4.6) after 30 days, and 2.3 (95% CI: 1.8-2.9) and 3.1 (95% CI: 2.2-4.2) after 1 year.
Conclusions:
SI identifies more patients with increased risk of mortality, and seems to be a more sensitive prognostic predictor than CS in patients with STEMI treated by primary PCI.
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