Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction
Key result
IABP-SHOCK II risk score stratifies cardiogenic shock patients, predicting ~77% 30-day mortality in high-risk cases.
- P<0.0001
Why the study?
Mortality in cardiogenic shock remains high, making early risk stratification crucial for adequate treatment decisions, but an easy-to-use risk prediction score for short-term mortality was needed.
Can the IABP-SHOCK II risk score accurately predict 30-day mortality in patients with cardiogenic shock after acute myocardial infarction?
Population
Patients with cardiogenic shock derived from IABP-SHOCK II with external validation in CardShock (n = 137)
Comparison
Risk categories (low: 0 to 2 vs intermediate: 3 or 4 vs high: 5 to 9)
Design
Risk prediction score development and validation study
Follow-up
30 days
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This is a huge clinical question now: how do we make an impact on the persistently high mortality despite early revascularization? Obviously [the introduction of] early revascularization was a huge improvement in care with a marked reduction in mortality, but we've been stuck ever since, with no further advance.”
“The IABP-SHOCK II risk score is a simple tool that can be rapidly calculated in the catheterization laboratory setting and applied in clinical routine. It might therefore serve for identifying patients for future clinical trials and, more importantly, it might help stratify patients according to their risk for short-term mortality and thus facilitate clinical decision-making.”
“While enhancing simplicity, dichotomization of continuous variables in a risk score can lead to overestimation or underestimation of risk, particularly for patients with values hovering around the selected cut points.”
Implication
May support early risk stratification in cardiogenic shock; leaves open external validation before clinical adoption.
Key Points
- The aim is to create an accessible risk prediction score for short-term mortality in cardiogenic shock patients.
- Developed using stepwise multivariable regression analysis from the IABP-SHOCK II trial.
- Identified six independent predictors for 30-day mortality to create risk categories.
- Validated in the IABP-SHOCK II registry and the CardShock trial populations.
- 30-day mortality rates were 23.8% (low), 49.2% (intermediate), and 76.6% (high) with p < 0.0001.
- The area under the curve was 0.79 for IABP-SHOCK II registry and 0.73 for CardShock validation.
- Kaplan-Meier analysis showed significant mortality differences between risk categories.
Study Design
Type
Observational
Structured PICO
Can the IABP-SHOCK II risk score accurately predict 30-day mortality in patients with cardiogenic shock after acute myocardial infarction?
P
Population
Patients with cardiogenic shock after acute myocardial infarction, used to derive and validate a risk prediction score for short-term mortality.
E
Exposure
IABP-SHOCK II risk score (6 variables: age >73 years, prior stroke, glucose >10.6 mmol/l, creatinine >132.6 μmol/l, TIMI flow <3 after PCI, arterial blood lactate >5 mmol/l)
O
Outcome
30-day mortalityhard clinical
Main Result
p-value: p=< 0.0001
The IABP-SHOCK II risk score is a simple, 6-variable tool that effectively stratifies 30-day mortality risk in patients with infarct-related cardiogenic shock.
Cite This Study
Pöss et al. (2017) conducted an observational in Cardiogenic shock after acute myocardial infarction. IABP-SHOCK II risk score vs. Low risk score category was evaluated on 30-day mortality (p=< 0.0001). The IABP-SHOCK II risk score stratified 30-day mortality in cardiogenic shock patients into low (23.8%), intermediate (49.2%), and high (76.6%) risk categories (p<0.0001).