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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort
Pedro Ivo M Moraes1, Claudia Rodrigues Alves1, Marco Tulio Souza1
1Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.
Insights
The IABP-SHOCK II score effectively predicts mortality in ST-elevation myocardial infarction (STEMI) patients experiencing cardiogenic shock after pharmacoinvasive therapy. Ischaemia time did not impact the score's risk stratification accuracy.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Risk Stratification
Background:
- ST-elevation myocardial infarction (STEMI) is a leading cause of cardiogenic shock.
- Pharmacoinvasive strategy (PhIS) is utilized for reperfusion in STEMI patients.
- Effective risk stratification is crucial for managing cardiogenic shock post-STEMI.
Purpose of the Study:
- To validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in STEMI patients treated with PhIS.
- To assess the impact of ischaemia time on risk stratification accuracy within different IABP-SHOCK II score strata.
Main Methods:
- Analysis of 2143 STEMI patients treated with tenecteplase and subsequent cardiac catheterisation.
- Stratification of patients into low, moderate, and high risk using the IABP-SHOCK II score (0-9).
- Comparison of 30-day mortality rates and analysis of pain-to-needle and fibrinolytic-catheterisation times.
Main Results:
- The IABP-SHOCK II score demonstrated good discrimination for 30-day mortality (AUC 0.73).
- Observed 30-day mortality rates were 26.6% (low-risk), 53.2% (moderate-risk), and 76% (high-risk).
- Ischaemia times (pain-to-needle and fibrinolytic-catheterisation) did not significantly influence risk stratification.
Conclusions:
- The IABP-SHOCK II score is adequate for risk stratification in STEMI patients with cardiogenic shock treated with PhIS.
- Ischaemia time does not affect the predictive ability of the IABP-SHOCK II score in this patient cohort.
- The score provides reliable prognostic information irrespective of reperfusion delays.
Objective:
To validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with pharmacoinvasive strategy (PhIS) and to analyse the influence of ischaemia time on different risk strata.
Methods:
We analysed 2143 patients with STEMI who underwent reperfusion with tenecteplase in primary health services between May 2010 and April 2017 and were transferred to a tertiary hospital for cardiac catheterisation and continuity of care. Those who evolved to cardiogenic shock were scored as low (0-2), moderate (3-4) or high (5-9) risk of death in 30 days and pairwise-log-rank test was used to compare strata. Time intervals between symptoms onset and lytic (pain-to-needle) and fibrinolytic-catheterisation were also compared.
Results:
Cardiogenic shock occurred in 212 (9.9%) individuals. The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62) and 76% for high-risk (n=25) analysed patients (p<0.001). Validation of the score showed good discrimination for death, area under the curve of 0.73 (CI: 0.66 to 0.81; p<0.001). The median intervals of pain-to-needle and fibrinolytic-catheterisation showed no association with the group stratification (220 vs 251 vs 200 min; p=0.22 and 390 vs 435 vs 315 min; p=0.18, respectively).
Conclusions:
In patients with cardiogenic shock after STEMI treated with PhIS, risk stratification using IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterisation times on the ability to the score model stratification.
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