Elevated shock index in STEMI patients undergoing primary PCI was associated with increased 8-year mortality (adjusted HR 1.06 per 0.1 unit increment; 95% CI 1.02-1.11; P=0.007).
Cohort (n=1,369)
Does elevated shock index predict long-term mortality in patients with STEMI undergoing PPCI?
Elevated shock index in STEMI patients is associated with increased risk of inhospital cardiogenic shock and mortality up to 8 years, though long-term adverse prognosis is almost entirely driven by events within the first 30 days.
Effect estimate: adjusted HR 1.06 (95% CI 1.02-1.11)
Absolute Event Rate: 36.1% vs 22.9%
p-value: p=0.007
BACKGROUND: The association of shock index with long-term mortality after ST-segment elevation myocardial infarction (STEMI) remains poorly investigated. We aimed to assess the association between shock index and eight-year mortality after STEMI. METHODS: The study included 1369 patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Patients were categorized into three groups: a group with shock index in the first tertile (shock index, 0.21 to 0.52; n = 458), a group with shock index in the second tertile (shock index > 0.52 to 0.67; n = 457) and a group with shock index in the third tertile (shock index > 0.67 to 2.80; n = 454). The primary outcome was eight-year mortality. RESULTS: In patients with shock index in the first to third tertiles, inhospital cardiogenic shock (n = 153) occurred in 3.5, 3.9 and 26.2% of patients, respectively adjusted odds ratio = 1.54, 95% confidence interval (CI) 1.40 to 1.69, P < 0.001; 30-day deaths (n = 122) occurred in 2.8, 5.5 and 18.5% of patients, respectively adjusted hazard ratio = 1.06 (1.01-1.12); P = 0.024; eight-year deaths (n = 300) occurred in 22.9, 21.6 and 36.1% of patients, respectively adjusted hazard ratio = 1.06 (1.02-1.11); P = 0.007 with all risk estimates calculated per 0.1 unit increment in shock index values. From 30 days to 8 years, deaths (n = 178) occurred in 20.7, 17.0 and 21.5% of patients in the first to third shock index tertiles, respectively (the difference was nonsignificant for all intertertile comparisons). CONCLUSIONS: In patients with STEMI, elevated shock index is associated with the risk of inhospital cardiogenic shock and mortality up to 8 years after PPCI. The long-term adverse prognosis was almost entirely driven by events within the first 30 days.
Ndrepepa et al. (Wed,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,369). Elevated shock index vs. Lower shock index was evaluated on eight-year mortality (adjusted HR 1.06, 95% CI 1.02-1.11, p=0.007). Elevated shock index in STEMI patients undergoing primary PCI was associated with increased 8-year mortality (adjusted HR 1.06 per 0.1 unit increment; 95% CI 1.02-1.11; P=0.007).
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