Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction

• Published in: Journal of the American College of Cardiology Vol. 69; no. 15; pp. 1913 - 1920
• Main Authors: Pöss, Janine, Köster, Jelena, Fuernau, Georg, Eitel, Ingo, de Waha, Suzanne, Ouarrak, Taoufik, Lassus, Johan, Harjola, Veli-Pekka, Zeymer, Uwe, Thiele, Holger, Desch, Steffen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 18.04.2017; Elsevier Limited
• Subjects: acute coronary syndrome; Acute coronary syndromes; Age; Aged; Aorta; Balloon treatment; Cardiology; Cardiovascular; Catheterization; Clinical trials; Coronary artery; Death; Diabetes; Diabetes mellitus; Electrocardiography; Ethics; Etiology; Female; Germany; Glucose; Heart attacks; Heart diseases; Humans; Hypotension; Injection; Intra-Aortic Balloon Pumping - methods; Intra-Aortic Balloon Pumping - statistics & numerical data; Intubation; Kaplan-Meier Estimate; Laboratories; Life span; Male; Mathematical models; Medical prognosis; Middle Aged; Mortality; Myocardial Infarction - complications; Outcome and Process Assessment (Health Care); Patients; percutaneous coronary intervention; Percutaneous Coronary Intervention - methods; Percutaneous Coronary Intervention - statistics & numerical data; Population studies; prognosis; Renal function; Research Design; Risk assessment; Risk Assessment - methods; risk score; Shock; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Statistical analysis; Studies; Thrombolytic Therapy - methods; Thrombolytic Therapy - statistics & numerical data; TIMI flow grade; Variables; IABP; CI; risk score; ROC; HR; prognosis; AUC; CS; percutaneous coronary intervention; GFR; acute coronary syndrome; PCI; mortality; CABG; AMI; TIMI flow grade; cardiogenic shock; receiver-operating characteristic; coronary artery bypass grafting; intra-aortic balloon pump; glomerular filtration rate; area under the curve; hazard ratio; confidence interval; acute myocardial infarction
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2017.02.027

Mortality in cardiogenic shock (CS) remains high. Early risk stratification is crucial to make adequate treatment decisions. This study sought to develop an easy-to-use, readily available risk prediction score for short-term mortality in patients with CS, derived from the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock) trial. The score was developed using a stepwise multivariable regression analysis. Six variables emerged as independent predictors for 30-day mortality and were used as score parameters: age >73 years, prior stroke, glucose at admission >10.6 mmol/l (191 mg/dl), creatinine at admission >132.6 μmol/l (1.5 mg/dl), Thrombolysis In Myocardial Infarction flow grade <3 after percutaneous coronary intervention, and arterial blood lactate at admission >5 mmol/l. Either 1 or 2 points were attributed to each variable, leading to a score in 3 risk categories: low (0 to 2), intermediate (3 or 4), and high (5 to 9). The observed 30-day mortality rates were 23.8%, 49.2%, and 76.6%, respectively (p < 0.0001). Validation in the IABP-SHOCK II registry population showed good discrimination with an area under the curve of 0.79. External validation in the CardShock trial population (n = 137) showed short-term mortality rates of 28.0% (score 0 to 2), 42.9% (score 3 to 4), and 77.3% (score 5 to 9; p < 0.001) and an area under the curve of 0.73. Kaplan-Meier analysis revealed a stepwise increase in mortality between the different score categories (0 to 2 vs. 3 to 4: p = 0.04; 0 to 2 vs. 5 to 9: p = 0.008). The IABP-SHOCK II risk score can be easily calculated in daily clinical practice and strongly correlated with mortality in patients with infarct-related CS. It may help stratify patient risk for short-term mortality and might, thus, facilitate clinical decision making. (Intraaortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II]; NCT00491036) [Display omitted]