A Risk Stratification Scheme for In-Hospital Cardiogenic Shock in Patients With Acute Myocardial Infarction

Abstract

Objective: Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) despite advances in care. This study aims to derive and validate a risk score for in-hospital development of CS in patients with AMI.

Methods: In this study, we used the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) registry of 76,807 patients for model development and internal validation. These patients came from 158 tertiary hospitals and 82 secondary hospitals between 2014 and 2019, presenting AMI without CS upon admission. The eligible patients with AMI were randomly assigned to derivation (n = 53,790) and internal validation (n = 23,017) cohorts. Another cohort of 2,205 patients with AMI between 2014 and 2016 was used for external validation. Based on the identified predictors for in-hospital CS, a new point-based CS risk scheme, referred to as the CCC-ACS CS score, was developed and validated.

Results: A total of 866 (1.1%) and 39 (1.8%) patients subsequently developed in-hospital CS in the CCC-ACS project and external validation cohort, respectively. The CCC-ACS CS score consists of seven variables, including age, acute heart failure upon admission, systolic blood pressure upon admission, heart rate, initial serum creatine kinase-MB level, estimated glomerular filtration rate, and mechanical complications. The area under the curve for in-hospital development of CS was 0.73, 0.71, and 0.85 in the derivation, internal validation and external validation cohorts, respectively.

Conclusion: This newly developed CCC-ACS CS score can quantify the risk of in-hospital CS for patients with AMI, which may help in clinical decision making.

Clinical trial registration: www.ClinicalTrials.gov, identifier: NCT02306616.

Keywords: acute myocardial infarction; cardiogenic shock; heart failure; heart rate; risk score.

Conflict of interest statement

GF consulted for Abbott, Amgen, AstraZeneca, Bayer, Edwards, Janssen, Medtronic, Merck, and Novartis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Yang, Ran, Li, Zhong, Smith, Wang, Fonarow, Qiu, Morgan, Wei, Chen, Huang, Hao, Zhou, Siu, Zhao, Chen and Yu.

Figures

Figure 1

Cohort selection for the main analysis. (A) for CCC-ACS registry and (B) for external validation dataset. ACS, acute coronary syndrome; AMI, acute myocardial infarction; CS, cardiogenic shock; NSTEMI, non-ST-segment elevation myocardial infarction; SBP, systolic blood pressure; STEMI, ST-segment elevation myocardial infarction.

Figure 2

Improving care for cardiovascular disease in China–acute coronary syndrome cardiogenic shock risk score. CS, cardiogenic shock; CK-MB, creatine kinase-MB; eGFR, estimated glomerular filtration rate; HR, heart rate; SBP, systolic blood pressure; ULN, upper limit of normal.

Figure 3

Calibration plots. Calibration plots showing observed vs. predicted incidence of in-hospital CS in the derivation (A), internal (B), and external (C) validation cohorts. The diagonal line indicates perfect calibration. CS, cardiogenic shock.