What is the clinical evidence from this study?

Study design: Cohort. Population: Geriatric (≥65 years) patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (n=711). Intervention: Hypoxia–Age–Shock Index (HASI) calculated at triage vs. Shock Index (SI) and Age–Shock Index (ASI). Primary outcome: All-cause in-hospital mortality during index hospitalization (OR 8.28 (multivariable adjusted for HASI), 95% CI 95% CI 1.47–47.2, p=0.017).

What question did this study set out to answer?

The study aims to evaluate the effectiveness of the Hypoxia–Age–Shock Index in predicting mortality among geriatric patients with STEMI undergoing primary PCI.

February 14, 2026Open Access

Use of the Hypoxia–Age–Shock Index at Triage to Predict Mortality in Geriatric STEMI Patients Undergoing Primary PCI

Q: What does this research mean for the field?

The triage-derived Hypoxia–Age–Shock Index (HASI) provides higher discrimination for in-hospital mortality compared to the Shock Index and Age-Shock Index in geriatric STEMI patients undergoing primary PCI. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

The triage-derived Hypoxia–Age–Shock Index showed numerically higher discrimination for in-hospital mortality with adjusted OR 8.28 (95% CI 1.47–47.2; p=0.017) compared to SI and ASI in geriatric STEMI patients undergoing primary PCI.

Key Points

The study aims to evaluate the effectiveness of the Hypoxia–Age–Shock Index in predicting mortality among geriatric patients with STEMI undergoing primary PCI.
Conducted a retrospective cohort analysis of 711 STEMI patients receiving primary PCI.
Calculated SI, ASI, and HASI using vital signs at triage prior to intervention.
Analyzed in-hospital and 30-day mortality with Kaplan-Meier survival analysis and multivariable Cox regression.
Assessed discriminative performance using ROC curves and DeLong’s test.
Elderly patients had significantly higher ASI and HASI values compared to younger patients.
In-hospital mortality was higher for patients aged ≥65 years (9.4% vs. 3.7%, p = 0.003).
HASI demonstrated the highest discriminative performance for mortality prediction (AUC 0.703 in elderly).
Age ≥ 65 years was identified as an independent predictor of 30-day mortality (adjusted HR 2.59).

Study Design

Type

Cohort (n=711)

Multicenter

Structured PICO

Does the Hypoxia-Age-Shock Index (HASI) improve prediction of in-hospital mortality compared to the Shock Index and Age-Shock Index in geriatric STEMI patients undergoing primary PCI?

Population

711 adult STEMI patients receiving primary PCI at a single tertiary center, including 254 geriatric patients aged ≥65 years.

Intervention

Hypoxia-Age-Shock Index (HASI) calculated using triage vital signs prior to intervention

Comparator

Shock Index (SI) and Age-Shock Index (ASI)

Outcome

In-hospital mortalityhard clinical

The Hypoxia-Age-Shock Index (HASI) provides better discrimination for in-hospital mortality than SI or ASI in STEMI patients undergoing primary PCI, serving as a simple triage tool.

Main Result

Effect estimate: OR 8.28 (multivariable adjusted for HASI) (95% CI 95% CI 1.47–47.2)

Absolute Event Rate: 9.4% vs 3.7%

p-value: p=0.017

Limitations

Retrospective single-center design with potential selection and information biases
No external validation of HASI performed
Difference in AUC values between indices not statistically significant
Moderate overall discrimination of indices
Limited to in-hospital and 30-day outcomes; no long-term prognostic data

Abstract

Background and Objectives: Older adults with ST-segment elevation myocardial infarction (STEMI) experience disproportionately high mortality despite advances in reperfusion therapy. The Shock Index (SI) and Age–Shock Index (ASI) offer rapid hemodynamic assessment but do not address hypoxia. The Hypoxia–Age–Shock Index (HASI), which incorporates oxygen saturation (SpO2), may improve early mortality prediction in geriatric STEMI. Materials and Methods: This retrospective cohort study included adult STEMI patients receiving primary percutaneous coronary intervention (PCI) at a tertiary center from 2019 to 2023. A total of 711 patients were analyzed, including 254 aged ≥65 years. SI, ASI, and HASI were calculated using triage vital signs prior to intervention. The primary outcome was in-hospital mortality. Thirty-day mortality was analyzed as a pre-specified secondary endpoint using Kaplan–Meier survival analysis and multivariable Cox regression. Discrimination was assessed using ROC curves with pairwise AUC comparison by DeLong’s test. Results: Elderly patients showed higher creatinine and troponin T levels, lower hemoglobin, and elevated ASI and HASI values (all p < 0.001). They had increased rates of cardiogenic shock (26.8% vs. 14.0%), major adverse events (26.0% vs. 10.1%), and in-hospital mortality (9.4% vs. 3.7%, p = 0.003). Age ≥ 65 years independently predicted 30-day mortality (adjusted HR 2.59, 95% CI 1.34–5.04). Among indices, HASI demonstrated the highest discriminative performance (AUC 0.703 in elderly; 0.743 in younger patients). Conclusions: In geriatric STEMI, HASI demonstrated numerically higher discriminative performance for in-hospital mortality compared with SI and ASI, supporting its use as a simple and rapid triage tool.

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