Simple risk stratification of patients with ST-segment elevation myocardial infarction: based on the modified DanGer...

We aimed to investigate association of three DanGer Shock trial criteria [systolic blood pressure [SBP] < 100 mmHg, lactate ≥ 2.5 mmol/L, and left ventricular ejection fraction (LVEF) < 45%] on clinical outcomes among patients with ST-elevation myocardial infarction (STEMI) in Japan and evaluate whether these criteria could serve as a simple prognostic model for risk stratification. This single-center, retrospective, observational study included 1,211 patients with STEMI who underwent percutaneous coronary intervention (PCI) between 2014 and October 2023. The primary outcome was all-cause mortality at 180 days after the index PCI. To estimate the predictor of all cause death, a multivariable logistic regression analysis was conducted, and a scoring system was developed based on the results of the analysis. Patients were stratified according to the derived scoring system, and the prognostic utility of this stratification was evaluated. Among them, 4.1% met all the 3 key inclusion criteria of the DanGer Shock trial. The overall 180-day mortality rate was 6.5%. In multivariable analysis, each of the 2 criteria (SBP < 100 mmHg and LVEF < 45%) was significantly associated with 180-day all-cause death. Based on a multivariable logistic regression model, a simple shock score was developed (SBP < 100 mmHg, 1 point; lactate ≥ 2.5 mmol/L, 1 point; and LVEF < 45%, 2 points). With higher total shock scores, 180-day mortality increased exponentially (score 0: 1.9%, score 1: 2.8%, score 2: 6.1%, score 3: 16.4%, score 4 points, 42.7%, log-rank P< 0.001). In real-world clinical practice, few patients with STEMI fulfilled the 3 key inclusion criteria of the DanGer Shock trial. The simple score based on modified DanGer Shock trial-derived criteria assessed at initial emergency room presentation effectively stratified 180-day mortality risk in patients with STEMI.