Abstract
ObjectiveCardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) despite advances in care. This study aims to derive and validate a risk score for in-hospital development of CS in patients with AMI.MethodsIn this study, we used the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC–ACS) registry of 76,807 patients for model development and internal validation. These patients came from 158 tertiary hospitals and 82 secondary hospitals between 2014 and 2019, presenting AMI without CS upon admission. The eligible patients with AMI were randomly assigned to derivation (n = 53,790) and internal validation (n = 23,017) cohorts. Another cohort of 2,205 patients with AMI between 2014 and 2016 was used for external validation. Based on the identified predictors for in-hospital CS, a new point-based CS risk scheme, referred to as the CCC–ACS CS score, was developed and validated.ResultsA total of 866 (1.1%) and 39 (1.8%) patients subsequently developed in-hospital CS in the CCC–ACS project and external validation cohort, respectively. The CCC–ACS CS score consists of seven variables, including age, acute heart failure upon admission, systolic blood pressure upon admission, heart rate, initial serum creatine kinase-MB level, estimated glomerular filtration rate, and mechanical complications. The area under the curve for in-hospital development of CS was 0.73, 0.71, and 0.85 in the derivation, internal validation and external validation cohorts, respectively.ConclusionThis newly developed CCC–ACS CS score can quantify the risk of in-hospital CS for patients with AMI, which may help in clinical decision making.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT02306616.
Highlights
Cardiogenic shock (CS) is defined as systemic tissue hypoperfusion secondary to inadequate cardiac output despite the adequate circulatory volume and left ventricular filling pressure
In the CCC–acute coronary syndrome (ACS) project, a total of 113,650 patients who presented with ACS were enrolled
A total of 76,807 patients with acute myocardial infarction (AMI) from the Cardiovascular Disease in China–Acute Coronary Syndrome (CCC–ACS) project were included in the final analysis; 53,790 were in the derivation cohort and 23,017 were in the internal validation cohort (Figure 1A)
Summary
Cardiogenic shock (CS) is defined as systemic tissue hypoperfusion secondary to inadequate cardiac output despite the adequate circulatory volume and left ventricular filling pressure. Among patients with acute myocardial infarction (AMI), 5.5–13% develop CS, mostly during the index acute coronary syndrome (ACS) hospitalization [1–3], and it is the most common cause of death in patients with ACS [4, 5]. The in-hospital mortality rate of patients who develop CS remains unacceptably high despite major advances, such as prompt revascularisation, in the management of AMI [1, 6–10]. There are only a few existing risk stratification models for CS in patients with AMI, deriving primarily from RCT data with inclusion/exclusion criteria, or from registries of selected subsets of patients with AMI [14–16], which limits generalization ability to real-world AMI populations. The development of a risk stratification system for CS using a large and real-world AMI population with high discriminatory power may improve the decision-making process and streamline the management of patients with AMI to prevent CS.
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