Abstract
BackgroundCardiogenic shock (CS) is a critical condition and the leading cause of mortality after acute myocardial infarction (AMI). Scores that predict mortality have been established, but a patient's clinical course is often nonlinear. Thus, factors present during acute care management may be explored. This study intended to develop a risk-predictive model for patients with CS.MethodsIn this observational study, adult patients who received inotropic support at the Emergency Room (ER) from January 2017 to August 2020 and were admitted to the cardiac care unit (CCU) with a diagnosis of CS were enrolled in this study. Patients with out-of-hospital cardiac arrest, inotropic support for bradycardia, and survival <24 h after ER arrival were excluded. A total of 311 patients were enrolled and categorized into derivation (n = 243) and validation (n = 68) cohorts.ResultsA history of coronary artery disease, multiple inotrope use, ejection fraction <40%, lower hemoglobin concentration, longer cardiopulmonary resuscitation duration, albumin infusion, and renal replacement therapy were identified as independent prognostic factors for in-hospital mortality. The cardiogenic shock prognosis (CSP) score was established as a nomogram and three risk groups were identified: low-risk (score 115, 0% of mortality), medium-risk (score 116–209, 8.75% of mortality), and high-risk (score 210, 66.67% of mortality). The area-under-the-curve (AUC) of the CSP score was 0.941, and the discrimination value in the validation cohort was consistent (AUC = 0.813).ConclusionsThe CSP score represents a risk-predictive model for in-hospital mortality in patients with CS in acute care settings. Patients identified as the high-risk category may have a poor prognosis.
Highlights
Cardiogenic shock (CS) is the most severe form of acute heart failure and as a state of ineffective cardiac output, it results in clinical and biochemical manifestations of inadequate tissue perfusion [1]
The epidemiology of shock has evolved in recent years with acute myocardial infarction (AMI)-related CS (AMICS) accounting for less than one-third of all CS cases, the role of hemodynamic stabilization using pharmacologic and nonpharmacologic therapies has been inconsistent [6, 7]
The incidence of coronary artery disease (CAD), heart failure, cardiomyopathy, and renal disease was determined to be higher in the patients who did not survive to discharge, whereas dyslipidemia was more frequent in the patients who survived
Summary
Cardiogenic shock (CS) is the most severe form of acute heart failure and as a state of ineffective cardiac output, it results in clinical and biochemical manifestations of inadequate tissue perfusion [1]. CS complicates up to 10% of cases of acute myocardial infarction (AMI) and is a leading cause of mortality after AMI [2]. The epidemiology of shock has evolved in recent years with AMI-related CS (AMICS) accounting for less than one-third of all CS cases, the role of hemodynamic stabilization using pharmacologic and nonpharmacologic therapies has been inconsistent [6, 7]. All these risk scores revealed modest prognostic accuracy, with an internal validation area under the curve (AUC) of.74, 0.79, and., respectively [3–5]. Cardiogenic shock (CS) is a critical condition and the leading cause of mortality after acute myocardial infarction (AMI). This study intended to develop a risk-predictive model for patients with CS
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