当前位置： SCI文献检索 > JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY期刊下所有文献 > Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction.

Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction.

Abstract：

BACKGROUND:Mortality in cardiogenic shock (CS) remains high. Early risk stratification is crucial to make adequate treatment decisions. OBJECTIVES: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. METHODS:The score was developed using a stepwise multivariable regression analysis. RESULTS: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). CONCLUSIONS: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).

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Pöss J,Köster J,Fuernau G,Eitel I,de Waha S,Ouarrak T,Lassus J,Harjola VP,Zeymer U,Thiele H,Desch S

doi

10.1016/j.jacc.2017.02.027

subject

Has Abstract

pub_date

2017-04-18 00:00:00

pages

1913-1920

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(17)30694-0

journal_volume

pub_type

杂志文章,随机对照试验

在线工具

Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction.