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Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction
Janine Pöss1, Jelena Köster1, Georg Fuernau1
1Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
Insights
A new risk score helps predict short-term mortality in cardiogenic shock (CS) patients. This easy-to-use tool stratifies risk, aiding clinical decisions for better patient outcomes.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Risk Stratification
Background:
- Mortality rates in cardiogenic shock (CS) remain high, necessitating early risk stratification.
- Effective treatment decisions depend on accurate assessment of patient risk.
Purpose of the Study:
- To develop a simple, accessible risk prediction score for short-term mortality in CS patients.
- The score was derived from data from the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial.
Main Methods:
- A stepwise multivariable regression analysis was employed to develop the risk score.
- Six independent predictors of 30-day mortality were identified and incorporated into the score.
Main Results:
- The score includes age, prior stroke, admission glucose and creatinine levels, post-PCI TIMI flow grade, and admission lactate.
- Risk categories (low, intermediate, high) showed significantly different 30-day mortality rates (23.8%, 49.2%, 76.6%).
- Validation in external cohorts confirmed good discrimination (AUC 0.79 and 0.73).
Conclusions:
- The IABP-SHOCK II risk score is easily calculable in clinical practice.
- The score strongly correlates with mortality in infarct-related CS.
- It aids in stratifying patient risk and facilitating clinical decision-making.
Background:
Mortality in cardiogenic shock (CS) remains high. Early risk stratification is crucial to make adequate treatment decisions.
Objectives:
This study sought to develop an easy-to-use, readily available risk prediction score for short-term mortality in patients with CS, derived from the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock) trial.
Methods:
The score was developed using a stepwise multivariable regression analysis.
Results:
Six variables emerged as independent predictors for 30-day mortality and were used as score parameters: age >73 years, prior stroke, glucose at admission >10.6 mmol/l (191 mg/dl), creatinine at admission >132.6 μmol/l (1.5 mg/dl), Thrombolysis In Myocardial Infarction flow grade <3 after percutaneous coronary intervention, and arterial blood lactate at admission >5 mmol/l. Either 1 or 2 points were attributed to each variable, leading to a score in 3 risk categories: low (0 to 2), intermediate (3 or 4), and high (5 to 9). The observed 30-day mortality rates were 23.8%, 49.2%, and 76.6%, respectively (p < 0.0001). Validation in the IABP-SHOCK II registry population showed good discrimination with an area under the curve of 0.79. External validation in the CardShock trial population (n = 137) showed short-term mortality rates of 28.0% (score 0 to 2), 42.9% (score 3 to 4), and 77.3% (score 5 to 9; p < 0.001) and an area under the curve of 0.73. Kaplan-Meier analysis revealed a stepwise increase in mortality between the different score categories (0 to 2 vs. 3 to 4: p = 0.04; 0 to 2 vs. 5 to 9: p = 0.008).
Conclusions:
The IABP-SHOCK II risk score can be easily calculated in daily clinical practice and strongly correlated with mortality in patients with infarct-related CS. It may help stratify patient risk for short-term mortality and might, thus, facilitate clinical decision making. (Intraaortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II]; NCT00491036).