Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: The ORBI risk score

Abstract

To derive and validate a readily-useable risk score to identify patients at high-risk of in-hospital STEMI-related CS. A total of 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. The ORBI risk score provides a readily useable and efficient tool to identify patients at high-risk of developing CS during hospitalization following STEMI, which may aid in further risk-stratification and thus potentially facilitate pre-emptive clinical decision making.