Comparison of risk prediction models in infarct-related cardiogenic shock

Abstract

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.

PRospective REgistry of PAtients in REfractory cardiogenic shock—The PREPARE CardShock registry

“…More likely, increasing age is associated with higher mortality in CS, regardless of shock severity as shown in a recent analysis of a large cohort of the Cardiogenic Shock Work Group registry, 31 a cohort of shock patients out of the Utah Cardiac Recovery shock database, 32 broad analysis of risk scores based on the CULPRIT-shock cohort 33 and most other trials and registries. 26,34,35 These findings are supported by our observation, too, as age was found to be a strong predictor of mortality, especially in patients with cardiac arrest.…”

Impella and venoarterial extracorporeal membrane oxygenation in cardiogenic shock complicating acute myocardial infarction

“…even reported lower in‐hospital mortality in AMICS patients with OHCA than in those without OHCA. Possibly, the absence of difference in mortality in patients with and without an OHCA can be explained by a possible very high shock severity (SCAI E) in our population 27 . Also, our study population differs from the general AMICS population by exclusion bias.…”

“…Possibly, the absence of difference in mortality in patients with and without an OHCA can be explained by a possible very high shock severity (SCAI E) in our population. 27 Also, our study population differs from the general AMICS population by exclusion bias. Supposedly, patients with severe neurological damage after OHCA did not receive Impella or VA-ECMO support.…”

Extracorporeal Membrane Oxygenation in Infarct-Related Cardiogenic Shock

“…Different scores were developed to assess CS severity and to support future identification of potentially suitable patients for mechanical circulatory support (e.g., IABP-SHOCK II Score, CardShock Score) [ 19 , 20 ]. Since these scores provided only modest predictive discrimination on external validation [ 21 ], the decision for mechanical circulatory support in clinical routine should not be based solely on these scores. The more objective CLIP-score based on laboratory values only gave promising results on predicting mortality in a recent publication [ 22 ].…”