From risk prediction to treatment guidance in cardiogenic shock: The role of bedside risk scores

From risk prediction to treatment guidance in cardiogenic shock: The role of bedside risk scores Despite the widespread availability of percutaneous coronary intervention (PCI) facilities and dedicated shock centres, short-term mortality among patients with infarct-related cardiogenic shock (AMICS) remains high, ranging from 45% to 64% [1,2].Whereas urgent PCI and PCI of the culprit lesion only were demonstrated to improve the outcomes in AMICS patients [3,4], data regarding the prognostic impact, optimal patient selection and timing for mechanical circulatory support (MCS) devices remain heterogeneous [5].Although there is evidence suggesting that MCS may be beneficial particularly in patients with shorter resuscitation durations [5], patient selection for MCS remains difficult.Readily applicable risk scores may help identify high-risk patients who could benefit from MCS or require closer invasive monitoring, and may support, but never replace, individualized discussions on treatment goals.Within the current issue of the International Journal of Cardiology: Heart & Vasculature, Mihali et al. introduced their so-called AMICS-ADMIT score to predict in-hospital mortality among AMICS patients undergoing PCI [6].Including 479 patients between 2017 and 2025, the authors developed a novel risk prediction tool comprising six variables (age, left ventricular ejection fraction, resuscitation and ST-segment elevation status, renal function, and vasoactive treatment) that are readily available, easy to obtain, and routinely assessed in clinical practice.The authors demonstrated reliable prediction of short-term mortality with an area under the curve of 0.81 and 0.78 of the adopted bedside AMICS-ADMIT score, comparable to established risk prediction tools, such as the CardShock or IABP-SHOCK II scores.Discrimination was maintained irrespective of MCS use overall, but attenuated within MCS-type subgroups, possibly owing to small sample sizes.The authors are to be commended for providing a simple tool that can be applied early after admission, that however, needs to be validated within larger prospective studies.Over the past decades, numerous risk scores have been developed for risk stratification in patients with AMICS or critically ill patients [7].Most of these scores have primarily been designed to predict clinical outcomes, concluding patients with higher predicted risk are generally subjected to closer clinical monitoring, while the treatment strategy typically remains largely unchanged.So far, risk scores in AMICS do not yet guide therapeutic decision-making, such as whether to initiate MCS in daily clinical practice and score-based inclusion or exclusion criteria were not considered within recent randomized controlled trials.Against the background of the potential benefits of early MCS initiation and advanced hemodynamic monitoring in certain subgroups of AMICS patients, readily applicable risk scores based on routinely available clinical data may be valuable for early risk stratification and guiding initial management decisions, particularly in the often complex and