Document Detail


A severity scoring system for risk assessment of patients with cardiogenic shock: a report from the SHOCK Trial and Registry.
MedLine Citation:
PMID:  20826251     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Early revascularization (ERV) is beneficial in the management of cardiogenic shock (CS) complicating myocardial infarction. The severity of CS varies widely, and identification of independent risk factors for outcome is needed. The effect of ERV on mortality in different risk strata is also unknown. We created a severity scoring system for CS and used it to examine the potential benefit of ERV in different risk strata using data from the SHOCK Trial and Registry.
METHODS: Data from 1,217 patients (294 from the randomized trial and 923 from the registry) with CS due to pump failure were included in a Stage 1 severity scoring system using clinical variables. A Stage 2 scoring system was developed using data from 872 patients who had invasive hemodynamic measurements. The outcome was in-hospital mortality at 30 days.
RESULTS: In-hospital mortality at 30 days was 57%. Multivariable modeling identified 8 risk factors (Stage 1): age, shock on admission, clinical evidence of end-organ hypoperfusion, anoxic brain damage, systolic blood pressure, prior coronary artery bypass grafting, noninferior myocardial infarction, and creatinine > or = 1.9 mg/dL (c-statistic = 0.74). Mortality ranged from 22% to 88% by score category. The ERV benefit was greatest in moderate- to high-risk patients (P = .02). The Stage 2 model based on patients with pulmonary artery catheterization included age, end-organ hypoperfusion, anoxic brain damage, stroke work, and left ventricular ejection fraction <28% (c-statistic = 0.76). In this cohort, the effect of ERV did not vary by risk stratum.
CONCLUSIONS: Simple clinical predictors provide good discrimination of mortality risk in CS complicating myocardial infarction. Early revascularization is associated with improved survival across a broad range of risk strata.
Authors:
Lynn A Sleeper; Harmony R Reynolds; Harvey D White; John G Webb; Vladimir Dzavík; Judith S Hochman
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-09     Completed Date:  2010-11-02     Revised Date:  2011-04-20    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  443-50     Citation Subset:  AIM; IM    
Copyright Information:
2010 Mosby, Inc. All rights reserved.
Affiliation:
New England Research Institutes, Watertown, MA 02472, USA. lsleeper@neriscience.com
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00000552
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MeSH Terms
Descriptor/Qualifier:
Aged
Female
Hospital Mortality*
Humans
Logistic Models
Male
Myocardial Infarction / complications,  surgery
Myocardial Revascularization
Registries
Risk Assessment
Severity of Illness Index*
Shock, Cardiogenic / etiology,  mortality*
Grant Support
ID/Acronym/Agency:
R01 HL49970/HL/NHLBI NIH HHS; R01 HL50020/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Am Heart J. 2011 Mar;161(3):e9; author reply e11   [PMID:  21392594 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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