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Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction.
- Source :
-
Journal of the American College of Cardiology (JACC) . Apr2017, Vol. 69 Issue 15, p1913-1920. 8p. - Publication Year :
- 2017
-
Abstract
- <bold>Background: </bold>Mortality in cardiogenic shock (CS) remains high. Early risk stratification is crucial to make adequate treatment decisions.<bold>Objectives: </bold>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.<bold>Methods: </bold>The score was developed using a stepwise multivariable regression analysis.<bold>Results: </bold>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).<bold>Conclusions: </bold>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). [ABSTRACT FROM AUTHOR]
- Subjects :
- *CARDIOGENIC shock
*MYOCARDIAL infarction complications
*MYOCARDIAL infarction risk factors
*PATIENTS
*CARDIOVASCULAR system
*COMPARATIVE studies
*EXPERIMENTAL design
*INTRA-aortic balloon counterpulsation
*RESEARCH methodology
*MEDICAL care
*EVALUATION of medical care
*MEDICAL cooperation
*MORTALITY
*RESEARCH
*RISK assessment
*THROMBOLYTIC therapy
*EVALUATION research
*RANDOMIZED controlled trials
*KAPLAN-Meier estimator
*THERAPEUTICS
MYOCARDIAL infarction-related mortality
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 69
- Issue :
- 15
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 122309726
- Full Text :
- https://doi.org/10.1016/j.jacc.2017.02.027