Comparison of risk prediction models in infarct-related cardiogenic shock.

Freund, Anne; Pöss, Janine; de Waha-Thiele, Suzanne; Meyer-Saraei, Roza; Fuernau, Georg; Eitel, Ingo; Feistritzer, Hans-Josef; Rubini, Maria; Huber, Kurt; Windecker, Stephan; Montalescot, Gilles; Oldroyd, Keith; Noc, Marko; Zeymer, Uwe; Ouarrak, Taoufik; Schneider, Steffen; Baran, David A; Desch, Steffen; Thiele, Holger (2021). Comparison of risk prediction models in infarct-related cardiogenic shock. European heart journal. Acute cardiovascular care, 10(8), pp. 890-897. Oxford University Press 10.1093/ehjacc/zuab054

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AIMS

Several prediction models have been developed to allow accurate risk assessment and provide better treatment guidance in patients with infarct-related cardiogenic shock (CS). However, comparative data between these models are still scarce. The objective of the study is to externally validate different risk prediction models in infarct-related CS and compare their predictive value in the early clinical course.

METHODS AND RESULTS

The Simplified Acute Physiology Score (SAPS) II Score, the CardShock score, the IABP-SHOCK II score, and the Society for Cardiovascular Angiography and Intervention (SCAI) classification were each externally validated in a total of 1055 patients with infarct-related CS enrolled into the randomized CULPRIT-SHOCK trial or the corresponding registry. The primary outcome was 30-day all-cause mortality. Discriminative power was assessed by comparing the area under the curves (AUC) in case of continuous scores. In direct comparison of the continuous scores in a total of 161 patients, the IABP-SHOCK II score revealed best discrimination [area under the curve (AUC = 0.74)], followed by the CardShock score (AUC = 0.69) and the SAPS II score, giving only moderate discrimination (AUC = 0.63). All of the three scores revealed acceptable calibration by Hosmer-Lemeshow test. The SCAI classification as a categorical predictive model displayed good prognostic assessment for the highest risk group (Stage E) but showed poor discrimination between Stages C and D with respect to short-term-mortality.

CONCLUSION

Based on the present findings, the IABP-SHOCK II score appears to be the most suitable of the examined models for immediate risk prediction in infarct-related CS. Prospective evaluation of the models, further modification, or even development of new scores might be necessary to reach higher levels of discrimination.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Windecker, Stephan
Subjects:	600 Technology > 610 Medicine & health
ISSN:	2048-8734
Publisher:	Oxford University Press
Language:	English
Submitter:	Nadia Biscozzo
Date Deposited:	20 Jan 2022 09:02
Last Modified:	05 Dec 2022 15:59
Publisher DOI:	10.1093/ehjacc/zuab054
PubMed ID:	34529043
Uncontrolled Keywords:	Acute myocardial infarction Outcome Prognosis Risk models Scores   Cardiogenic shock
URI:	https://boris.unibe.ch/id/eprint/163186