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September 10, 2026Heart and VesselsOpen Access

Simple risk stratification of patients with ST-segment elevation myocardial infarction: based on the modified DanGer shock trial-derived criteria assessed at initial emergency room presentation

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Key result

Modified DanGer shock score stratifies STEMI risk, linking the highest score to ~43% 180-day mortality.

  • HR 19.0
  • 95% CI 8.76-41.35
  • P<0.001
  • n=1,211

Why the study?

To investigate the association of three DanGer Shock trial criteria with clinical outcomes in patients with STEMI in Japan and evaluate them as a simple prognostic risk stratification model.

Population

1,211 patients with STEMI who underwent PCI in Japan

Comparison

Risk stratification by a scoring system based on three DanGer Shock trial criteria

Design

Single-center retrospective observational study

Follow-up

180 days

Authors

NTNarumi TaninobuKurashiki Central HospitalYSYuichi SawayamaShiga University of Medical ScienceMFMikitaka FujitaKurashiki Central Hospital

Discussion

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Implication

May aid STEMI risk stratification; extends DanGer criteria observationally but leaves open therapeutic impact.

Key Points

  • To investigate the association of three DanGer Shock trial criteria with clinical outcomes in STEMI and evaluate whether they could serve as a simple prognostic risk stratification score.
  • Conducted a single-center, retrospective, observational study of 1,211 patients with STEMI who underwent percutaneous coronary intervention (PCI) between 2014 and October 2023.
  • Developed a shock score using multivariable logistic regression based on emergency room variables: systolic blood pressure < 100 mmHg (1 point), lactate ≥ 2.5 mmol/L (1 point), and left ventricular ejection fraction < 45% (2 points).
  • Only 4.1% of patients met all 3 key inclusion criteria of the DanGer Shock trial, and the overall 180-day all-cause mortality rate was 6.5%.
  • All-cause mortality at 180 days increased exponentially with higher shock scores: score 0: 1.9%, score 1: 2.8%, score 2: 6.1%, score 3: 16.4%, and score 4: 42.7% (log-rank P< 0.001).
  • Compared to score 0, the hazard of 180-day death was significantly elevated for score 2 (adjusted HR 2.40, 95% CI 1.03–5.61, p = 0.04), score 3 (adjusted HR 6.43, 95% CI 3.04–13.61, p < 0.001), and score 4 (adjusted HR 19.0, 95% CI 8.76–41.35, p < 0.001).

Study Design

Type

Observational (n=1,211)

Multicenter

No

Structured PICO

P
Population
1,211 patients with ST-elevation myocardial infarction who underwent percutaneous coronary intervention, followed for 180 days to evaluate a shock scoring system.
E
Exposure
Simple shock score based on modified DanGer Shock trial criteria (systolic blood pressure < 100 mmHg [1 point], lactate ≥ 2.5 mmol/L [1 point], and left ventricular ejection fraction < 45% [2 points])
O
Outcome
All-cause mortality at 180 days after the index PCIhard clinical

Main Result

Hazard Ratio: 19 (95% CI 8.76–41.35)

Absolute Event Rate: 42.7% vs 1.9%

p-value: p=<0.001

A simple shock score based on modified DanGer Shock trial criteria (SBP < 100 mmHg, lactate ≥ 2.5 mmol/L, LVEF < 45%) effectively stratifies 180-day mortality risk in patients with STEMI.

Limitations

  • Single-center, retrospective, observational study design.
  • The ability of the shock score to stratify mortality has not been validated in other cohorts.
  • Left ventricular ejection fraction was evaluated by visual estimation, which may be less accurate.
  • Excluded 775 patients lacking data on SBP, lactate, or LVEF, potentially introducing selection bias.
  • Post-baseline factors such as in-hospital complications and discharge medications were not included.
  • Lactate data was obtained from either arterial or venous blood samples without a predefined protocol.
  • Included all patients with STEMI rather than specifically targeting patients in shock.
  • Included patients who were in a coma and experiencing cardiopulmonary arrest.
  • Timing and context of variable assessment differed from the original DanGer shock trial.

Cite This Study

Taninobu et al. (2026) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=1,211). Modified DanGer Shock trial-derived criteria score (Score 4) vs. Score 0 (no criteria met) was evaluated on All-cause mortality at 180 days after the index PCI (HR 19.0, 95% CI 8.76-41.35, p=<0.001). A simple shock score based on modified DanGer Shock trial criteria effectively stratified 180-day mortality risk in STEMI patients, with mortality increasing from 1.9% (score 0) to 42.7% (score 4).

synapsesocial.com/papers/6aa27aca58559d80afc73873https://doi.org/10.1007/s00380-026-02754-4
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Applying DanGer Shock Eligibility Criteria to a Real‐World Cohort of Cardiogenic Shock Patients2025
  2. 2Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation2018 · 3 citations
  3. 3Ability of a novel shock index that incorporates invasive hemodynamics to predict mortality in patients with ST ‐elevation myocardial infarction2021 · 5 citations
  4. 4Clinical Picture and Risk Prediction of Short-Term Mortality in Cardiogenic Shock2015 · 811 citations
  5. 5Association of shock index with short-term and long-term prognosis after ST-segment elevation myocardial infarction2019 · 9 citations