The use of bedside haemodynamic parameters to predict risk and in-hospital outcomes in non-ST elevation acute coronary syndromes: data from resource- limited settings in Iraq

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Abstract Funding Acknowledgements Type of funding sources: None. Background There is lack of data on the value of bedside hemodynamic parameters in predicting risk and outcomes in NSTE-ACS. This study aimed to assess if the following bedside haemodynamic tests : mean arterial pressure (MAP) [DBP + 1/3(SBP-DBP)], shock index (SI) [heart rate/SBP], pulse pressure (PP) [SBP-DBP] and proportional PP (PPP) [PP/SBP] can predict risk and adverse in-hospital outcomes in NSTE-ACS. Purpose To assess if bedside haemodynamic tests like mean arterial pressure (MAP), shock index (SI), pulse pressure (PP) and proportional PP (PPP) can predict risk and adverse in-hospital outcomes in NSTE-ACS Methods Patients with NSTE-ACS were prospectively included, we calculate GRACE score, SI, MAP, PP and PPP. Patients were stratified into low, intermediate and high GRACE risk class Results n.=179. When stratifying patients according to SI ≥0.7 vs <0.7: 31% had SI≥0.7, those with SI ≥0.7 were at high GRACE risk class in 52.5% vs 24.3%, p < 0.001. AF was recorded in those with SI≥0.7 in 19.7% vs 3.7%, p < 0.001. Time to catheterization (days) was 3.26 ± 2.55 in SI ≥0.7 vs 3.23 ± 1.96, p = 0.9, hospitalization duration (days) 5.11 ± 2.8 in SI ≥0.7 vs 4.8 ± 2.7, p = 0.4. For those who developed cardiogenic shock; MAP was 86.1 ± 17.6 vs 100.04 ± 15.3, p = 0.03 and SI was 0.91 ± 0.3 vs 0.63 ± 0.2, p = 0.02 compared to those who did not develop cardiogenic shock. No significant differences observed in PP and PPP between two groups. There was significant correlation between SI and GRACE score, p < 0.001 as well as with EF%, p < 0.001. MAP correlated significantly with GRACE score, p = 0.001. On multiple regression analysis: high GRACE risk class [95% CI 0.002-0.056, p = 0.03] and SI≥0.7 [95%CI 0.007-0.12, p = 0.02] were significant predictors of in-hospital death, while high GRACE risk class predicted in-hospital AHF [95% CI 0.13-0.26, p < 0.001]. SI≥0.7 predicted in-hospital stroke [95% CI 0.008-0.082, P = 0.01]. While MAP, PP and PPP did not predict in-hospital outcomes Conclusions SI correlates with GRACE score and predicted in-hospital stroke and death in NSTE-ACS. MAP correlated with GRACE score, but MAP, PP and PPP did not predict in-hospital outcomes. SI is readily obtainable than GRACE score and can be used to guide management particularly in resources-limited settings where proper risk stratification is needed to choose those who will benefit the most from invasive strategy Abstract Figure.