Review of the SEX-SHOCK Score

Cardiogenic shock remains the leading cause of in-hospital mortality after acute coronary syndromes, with persistently high fatality rates underscoring the need for accurate early risk stratification. The ORBI risk score was the first tool specifically designed to predict in-hospital cardiogenic shock in ACS patients undergoing PCI, but its discriminative performance is modest and sex-dependent, with lower accuracy in females. Leveraging large multinational cohorts and contemporary modeling techniques, the SEX-SHOCK score integrates key clinical, biological, and functional variables to address these limitations. Its superior and consistent performance across sexes and validation cohorts supports its preferential use for individualized risk prediction, trial design, and modern ACS management.