Key result
High SI and mSI linked to ~42% higher long-term mortality in AMI patients.
Why the study?
Shock index and modified shock index predict short-term mortality in acute myocardial infarction, but their association with long-term mortality has not been sufficiently examined.
Do high shock index and modified shock index predict long-term mortality in patients with acute myocardial infarction?
Cohort (n=10,174)
Do high shock index and modified shock index predict long-term mortality in patients with acute myocardial infarction?
Effect estimate: HR 1.42 for SI; HR 1.46 for mSI (95% CI 1.32-1.52 for SI; 1.36-1.57 for mSI)
High shock index and modified shock index are strong predictors of long-term mortality in patients with acute myocardial infarction, particularly in NSTEMI cases.
May support SI/mSI for long-term AMI risk stratification; extends prior data but leaves open prospective validation before practice change.
BACKGROUND: Shock index (SI) and modified shock index (mSI) are useful instruments for early risk stratification in acute myocardial infarction (AMI) patients. They are strong predictors for short-term mortality. Nevertheless, the association between SI or mSI and long-term mortality in AMI patients has not yet been sufficiently examined. MATERIAL AND METHODS: For this study, a total of 10,174 patients with AMI was included. All cases were prospectively recorded by the population-based Augsburg Myocardial Infarction Registry from 2000 until 2017. Endpoint was all-cause mortality with a median observational time of 6.5 years [IQR: 3.5-7.4]. Using ROC analysis and calculating Youden-Index, the sample was dichotomized into a low and a high SI and mSI group, respectively. Moreover, multivariable adjusted COX regression models were calculated. All analyses were performed for the total sample as well as for STEMI and NSTEMI cases separately. RESULTS: Optimal cut-off values were 0.580 for SI and 0.852 for mSI (total sample). AUC values were 0.6382 (95% CI: 0.6223-0.6549) for SI and 0.6552 (95% CI: 0.6397-0.6713) for mSI. Fully adjusted COX regression models revealed significantly higher long-term mortality for patients with high SI and high mSI compared to patients with low indices (high SI HR: 1.42 [1.32-1.52], high mSI HR: 1.46 [1.36-1.57]). Furthermore, the predictive ability was slightly better for mSI compared to SI and more reliable in NSTEMI cases compared to STEMI cases (for SI and mSI). CONCLUSION: High SI and mSI are useful tools for early risk stratification including long-term outcome especially in NSTEMI cases, which can help physicians to make decision on therapy. NSTEMI patients with high SI and mSI might especially benefit from immediate invasive therapy.Key messagesShock index and modified shock index are predictors of long-term mortality after acute myocardial infarction.Both indices predict long-term mortality not only for STEMI cases, but even more so for NSTEMI cases.
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Schmitz et al. (2022) conducted a cohort in Acute myocardial infarction (AMI) (n=10,174). High shock index (SI) and modified shock index (mSI) vs. Low SI and mSI was evaluated on All-cause mortality (HR 1.42 for SI; HR 1.46 for mSI, 95% CI 1.32-1.52 for SI; 1.36-1.57 for mSI). High shock index (SI) and modified shock index (mSI) were associated with significantly higher long-term all-cause mortality in AMI patients (high SI HR 1.42, 95% CI 1.32-1.52).
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