Ability of a novel shock index that incorporates invasive hemodynamics to predict mortality in patients with ST‐elevation myocardial infarction. Issue 1 (9th January 2021)

• Record Type: Journal Article
• Authors: McKenzie, Alexander; Zhou, Cynthia; Svendsen, Christopher; Anketell, Rebecca; Behroozi, Arash; Jessa, Dafe; Piehl, Charles; Rayson, Robert; Yeung, Michael; Stouffer, George A.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 98:Issue 1(2021)
• Page Start: 87
• Page End: 94
• Publication Date: 2021-01-09
• Subjects: hemodynamics -- mortality -- shock index -- STEMI; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29460
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objective: To determine whether the use of invasively measured hemodynamics improves the prognostic ability of a shock index (SI). Background: SI such as Admission‐SI, Age‐SI, Modified SI (MSI), and Age‐MSI predict short‐term mortality in ST‐elevation myocardial infarction (STEMI). Methods: Single‐center study of 510 patients who underwent primary percutaneous coronary intervention. STEMI SI was defined as age × heart rate (HR) divided by coronary perfusion pressure (CPP). Results: The mean age was 62 ± 14 years, 66% were males with hypertension (69%), tobacco use (38%), diabetes (28%) and chronic kidney disease (6%). The mean HR, systolic blood pressure (SBP), and CPP were 81 ± 18 bpm, 124 ± 28 mmHg, and 52.8 ± 16.3 mmHg, respectively. Patients with STEMI SI ≥182 ( n = 51) were more likely to experience a cardiac arrest in the catheterization laboratory (9.8% vs. 2.0%; p = .001), require mechanical circulatory support (47.1% vs. 8.5%; p < .0001) and be treated with vasopressors (56.9% vs. 10.7%; p < .0001) compared to STEMI SI < 182 ( n = 459). After multivariate adjustment, patients with STEMI SI ≥182 were 10, 10.1 and 4.8 times more likely to die during hospitalization, at 30 days and at 5 years, respectively. The C statistic of STEMI SI was 0.870, similar to GRACE score (AUC = 0.902; p = .29) and TIMI STEMI score (AUC = 0.895; p = .36). Conclusion: STEMI SI is an easy to calculate risk score that identifies STEMI patients at high risk of in‐hospital death.