Development of an Acute Coronary Syndrome-Cardiogenic Shock Risk Score for 30-day Mortality From the Victorian...

Area of Science:

• Cardiology
• Clinical Risk Stratification
• Outcomes Research

Background:

• Acute coronary syndrome-cardiogenic shock (ACS-CS) has a high 30-day mortality rate of approximately 50%.
• Effective prognostication is crucial for managing these high-risk patients.
• A simple bedside risk score can aid in rapid risk assessment.

Purpose of the Study:

• To develop and validate a simple bedside risk score for predicting 30-day all-cause mortality in patients with ACS-CS.
• To identify key clinical and procedural predictors of mortality in this population.

Main Methods:

• Analysis of data from 1564 consecutive patients with ACS-CS undergoing percutaneous coronary intervention (PCI) from the Victorian Cardiac Outcomes Registry (VCOR) (2013-2021).
• Internal validation using 1000 bootstrapped samples to identify robust predictors.
• Model performance evaluated using C-statistic and Hosmer-Lemeshow (HL) statistic.

Main Results:

• The study identified key predictors of 30-day mortality including age, female sex, diabetes, reduced estimated glomerular filtration rate, low left ventricular ejection fraction, out-of-hospital cardiac arrest, pre-procedural intubation, mechanical circulatory support, STEMI, and multivessel PCI.
• The validated risk score demonstrated excellent fit and performance (C-statistic = 0.8, HL p = 0.44).
• In-hospital and 30-day mortality rates were 42% and 45%, respectively.

Conclusions:

• A risk score incorporating peri-procedural variables accurately stratifies 30-day mortality risk in ACS-CS patients undergoing PCI.
• The score's simplicity suggests potential for clinical practice translation.
• External validation is recommended for the VCOR ACS-CS risk score.