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V Auffret, Y Cottin, G Leurent, M Gilard, J C Beer, A Zabalawi, F Chague, E Filippi, D Brunet, J P Hacot, A Loirat, L Lorgis, R Didier, M Zeller, H Le Breton, the ORBI and RICO investigators, P2482
Prediction of in-hospital cardiogenic shock development among patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention, European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy565.P2482, https://doi.org/10.1093/eurheartj/ehy565.P2482Close - Share Icon Share
Extract
Aims: To derive and validate a simple risk score to identify patients at high-risk of in-hospital STEMI-related CS.
Methods and results: 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire Régional Breton sur l'Infarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Côte-d'Or (RICO) constituted the external validation cohort. Stepwise multivariable logistic regression was used to build the score. Eleven variables were independently associated with the development of in-hospital CS: age >70 years, prior stroke/transient ischemic attack, cardiac arrest upon admission, anterior STEMI, first medical contact-to-pPCI delay >90 min, Killip class, heart rate >90/min, a combination of systolic blood pressure <125 mmHg and pulse pressure <45 mmHg, glycaemia >10 mmol/l, culprit lesion of the left main coronary artery, and post-pPCI Thrombolysis In Myocardial Infarction flow grade <3. The score derived from these variables allowed the classification of patients into 4 risk categories: low (0–7), low-to-intermediate (8–10), intermediate-to-high (11–12), and high (≥13). Observed in-hospital CS rates were 1.3%, 6.6%, 11.7%, and 31.8%, across the 4 risk categories respectively. Validation in the RICO cohort demonstrated in-hospital CS rates of 3.1% (score 0–7), 10.6% (score 8–10), 18.1% (score 11–12), and 34.1% (score ≥13). The score demonstrated high discrimination (c-statistic of 0.84 in the derivation cohort, 0.80 in the validation cohort) and adequate calibration in both cohorts.
