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Published on: June 12, 2021
Age shock index and age-modified shock index are strong predictors of outcomes in ST-segment elevation myocardial
Insights
New age shock index (age SI) and age-modified shock index (age MSI) effectively predict mortality in ST-elevation myocardial infarction (STEMI) patients. These simpler indicators outperform traditional shock index and GRACE score for risk stratification.
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Risk Prediction
Background:
- Early identification of high-risk patients is crucial for timely clinical intervention and disease management.
- Predictive values of age-modified shock index (age MSI) and age shock index (age SI) in ST-segment elevation myocardial infarction (STEMI) patients undergoing emergency percutaneous coronary intervention (PCI) are not well-established.
- Comparison with traditional shock index (SI), modified shock index (MSI), and the Global Registry of Acute Coronary Events (GRACE) risk score is needed.
Purpose of the Study:
- To evaluate the predictive performance of age SI and age MSI for cardiovascular events and mortality in STEMI patients undergoing emergency PCI.
- To compare the predictive capabilities of age SI and age MSI against SI, MSI, and the GRACE risk score.
Main Methods:
- Retrospective cohort study analyzing 983 STEMI patients who underwent emergency PCI.
- Data collected between January 2014 and September 2017.
- Primary outcomes included in-hospital cardiovascular events, and 6-month and long-term all-cause mortality.
Main Results:
- Age SI and age MSI demonstrated superior predictive value for in-hospital cardiac mortality, 6-month mortality, and long-term mortality compared to SI and MSI.
- The predictive performance of age SI and age MSI was comparable to the GRACE risk score for most outcomes.
- Multivariate analyses showed significant predictive values for age SI and age MSI (e.g., age MSI ROC-AUC = 0.84 for long-term mortality).
Conclusions:
- Age SI and age MSI are robust predictors of cardiovascular events and mortality in STEMI patients undergoing emergency PCI.
- These novel indices offer a simpler and potentially more convenient alternative to the GRACE score for risk stratification.
- Age SI and age MSI provide enhanced predictive power over traditional SI and MSI.
Background:
Early identification of high-risk patients provides clinicians with greater decision-making time and better informs strategies to cope with disease. The predictive values of age shock index (age SI) and age-modified shock index (age MSI) in ST-segment elevation myocardial infarction (STEMI) patients undergoing emergency percutaneous coronary intervention (PCI) have rarely been reported, especially compared with those for SI, MSI, and the Global Registry of Acute Coronary Events (GRACE) risk score.
Patients And Methods:
Nine hundred and eighty-three STEMI patients undergoing emergency PCI between January 2014 and September 2017 were analyzed in a retrospective cohort study. The primary outcomes were rates of in-hospital cardiovascular events, and 6-month and long-term all-cause mortality.
Results:
In multivariate analyses, the predictive values of age SI and age MSI were comparable to that of the GRACE score, but superior to those of SI and MSI for in-hospital cardiac mortality [age SI: odds ratio (OR) = 1.05, P < 0.001, area under the receiver operating characteristic (ROC-AUC) = 0.805, P < 0.001; age MSI: OR = 1.04, P < 0.001, ROC-AUC = 0.813, P < 0.001; GRACE score: OR = 1.03, P < 0.001, ROC-AUC = 0.827, P < 0.001], 6-month all-cause mortality (age SI: OR = 1.04, P < 0.001, ROC-AUC = 0.791, P < 0.001; age MSI: OR = 1.03, P < 0.001, ROC-AUC = 0.801, P < 0.001; GRACE score: ROC-AUC = 0.828, P < 0.001), long-term all-cause mortality [age SI: hazard ratio (HR) = 1.06, P < 0.001, ROC-AUC = 0.798, P < 0.001; age MSI: HR = 1.04, P < 0.001, ROC-AUC = 0.84, P < 0.001; GRACE score: ROC-AUC = 0.822, P < 0.001] and post-discharge all-cause mortality (age SI: HR = 1.05, P < 0.001, ROC-AUC = 0.78, P = 0.001; age MSI: HR = 1.05, P < 0.001, ROC-AUC = 0.789, P < 0.001; GRACE score: ROC-AUC = 0.812, P < 0.001).
Conclusion:
Age SI and age MSI are stronger predictors than SI and MSI for in-hospital cardiovascular events, and 6-month and long-term all-cause mortality in STEMI patients undergoing emergency PCI. Age SI and age MSI appear to be convenient and simpler indicators than the GRACE score.
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