Shock index-C (>21.0) demonstrated better discrimination for in-hospital mortality in STEMI patients compared to SI and MSI, with a sensitivity of 67.2% and specificity of 83.5%.
Cohort (n=1,552)
Does the Shock Index-C (SIC) improve prediction of in-hospital mortality compared to other shock indices and TIMI risk scales in adult STEMI patients undergoing PCI?
Shock Index-C (SIC) demonstrates superior discrimination for in-hospital mortality in STEMI patients undergoing PCI compared to traditional shock indices and TIMI risk scales.
Background: ST-segment elevation myocardial infarction (STEMI) is a leading cause of death worldwide. A shock index (SI), modified SI (MSI), delta-SI, and shock index-C (SIC) are known predictors of STEMI. This retrospective cohort study was designed to compare the predictive value of the SI, MSI, delta-SI, and SIC with thrombolysis in myocardial infarction (TIMI) risk scales. Method: Patients > 20 years old with STEMI who underwent percutaneous coronary intervention (PCI) were included. Receiver operating characteristic (ROC) curve analysis with the Youden index was performed to calculate the optimal cutoff values for these predictors. Results: Overall, 1552 adult STEMI cases were analyzed. The thresholds for the emergency department (ED) SI, MSI, SIC, and TIMI risk scales for in-hospital mortality were 0.75, 0.97, 21.00, and 5.5, respectively. Accordingly, ED SIC had better predictive power than the ED SI and ED MSI. The predictive power was relatively higher than TIMI risk scales, but the difference did not achieve statistical significance. After adjusting for confounding factors, the ED SI > 0.75, MSI > 0.97, SIC > 21.0, and TIMI risk scales > 5.5 were statistically and significantly associated with in-hospital mortality of STEMI. Compared with the ED SI and MSI, SIC (>21.0) had better sensitivity (67.2%, 95% CI, 58.6−75.9%), specificity (83.5%, 95% CI, 81.6−85.4%), PPV (24.8%, 95% CI, 20.2−29.6%), and NPV (96.9%, 95% CI, 96.0−97.9%) for in-hospital mortality of STEMI. Conclusions: SIC had better discrimination ability than the SI, MSI, and delta-SI. Compared with the TIMI risk scales, the ACU value of SIC was still higher. Therefore, SIC might be a convenient and rapid tool for predicting the outcome of STEMI.
Chiang et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,552). Shock index-C (SIC) vs. TIMI risk scales, SI, MSI, and delta-SI was evaluated on In-hospital mortality. Shock index-C (>21.0) demonstrated better discrimination for in-hospital mortality in STEMI patients compared to SI and MSI, with a sensitivity of 67.2% and specificity of 83.5%.