A Risk Stratification Scheme for In-Hospital Cardiogenic Shock in Patients With Acute Myocardial Infarction
Jun-Qing Yang1, Peng Ran1, Jie Li1
1Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
A new risk score, the CCC-ACS CS score, helps predict cardiogenic shock (CS) in acute myocardial infarction (AMI) patients. This tool aids clinicians in identifying high-risk individuals for better management.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Acute Myocardial Infarction Management
Background:
- Cardiogenic shock (CS) remains a primary cause of mortality in acute myocardial infarction (AMI) patients.
- Despite therapeutic advancements, predicting CS development in AMI is crucial for timely intervention.
Purpose of the Study:
- To develop and validate a risk score for predicting in-hospital cardiogenic shock in patients with acute myocardial infarction.
- To create a practical tool for clinical decision-making in AMI management.
Main Methods:
- Utilized the CCC-ACS registry (76,807 patients) for derivation and internal validation of the risk score.
- External validation was performed on a separate cohort of 2,205 AMI patients.
- Identified key predictors and developed a point-based risk scheme, the CCC-ACS CS score.
Main Results:
- The CCC-ACS CS score incorporates seven variables: age, acute heart failure, systolic blood pressure, heart rate, CK-MB, eGFR, and mechanical complications.
- The score demonstrated good predictive performance with AUCs of 0.73 (derivation), 0.71 (internal validation), and 0.85 (external validation).
- In-hospital CS developed in 1.1% and 1.8% of patients in the main and external validation cohorts, respectively.
Conclusions:
- The CCC-ACS CS score effectively quantifies the risk of in-hospital CS in AMI patients.
- This validated score can assist clinicians in risk stratification and clinical decision-making for AMI patients.
- The tool aims to improve outcomes by identifying patients at higher risk for cardiogenic shock.
Objective:
Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) despite advances in care. This study aims to derive and validate a risk score for in-hospital development of CS in patients with AMI.
Methods:
In this study, we used the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) registry of 76,807 patients for model development and internal validation. These patients came from 158 tertiary hospitals and 82 secondary hospitals between 2014 and 2019, presenting AMI without CS upon admission. The eligible patients with AMI were randomly assigned to derivation (n = 53,790) and internal validation (n = 23,017) cohorts. Another cohort of 2,205 patients with AMI between 2014 and 2016 was used for external validation. Based on the identified predictors for in-hospital CS, a new point-based CS risk scheme, referred to as the CCC-ACS CS score, was developed and validated.
Results:
A total of 866 (1.1%) and 39 (1.8%) patients subsequently developed in-hospital CS in the CCC-ACS project and external validation cohort, respectively. The CCC-ACS CS score consists of seven variables, including age, acute heart failure upon admission, systolic blood pressure upon admission, heart rate, initial serum creatine kinase-MB level, estimated glomerular filtration rate, and mechanical complications. The area under the curve for in-hospital development of CS was 0.73, 0.71, and 0.85 in the derivation, internal validation and external validation cohorts, respectively.
Conclusion:
This newly developed CCC-ACS CS score can quantify the risk of in-hospital CS for patients with AMI, which may help in clinical decision making.
Clinical Trial Registration:
www.ClinicalTrials.gov, identifier: NCT02306616.
More Related Videos
05:16Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Introduction Cardiac Emergencies