Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Shangguan, Qing; Xu, Jianpeng; Su, Hai; Li, Juxiang; Wang, Wenying; Hong, Kui; Cheng, Xiaoshu

doi:10.1016/j.ajem.2015.04.066

Cited by 53 publications

(56 citation statements)

References 22 publications

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“…This was associated with a highly significant increase of incidence of HF. That was in agreement with results of Qing Shangguan et al [21], who showed that with MSI > 1.4, there was a highly significant increase of incidence of 7-day MACE, fatal arrhythmia, and all-cause mortality, and there was a significant increase of incidence of Killip class, but he found no significant increase in incidence of cardiogenic shock [21].…”

Section: Discussionsupporting

confidence: 82%

“…That was in agreement with Bi Huang et al [20], who showed if ASI>0.7, there was a highly significant increase of incidence of 7-day HF, cardiogenic shock, fatal arrhythmia, arrest, and mortality [20]. While in the study done by Qing Shangguan et al [21], with ASI > 0.7 there was a significant increase of incidence of 7-day MACE, Killip class, fatal arrhythmia, and all-cause mortality, but they found no significant increase in incidence of cardiogenic shock [21]. Dana Bilkova et al [22], used a SI cut off=0.8, they worked on evaluating the relation between SI and the in-hospital mortality, they showed that with ASI > 0.8, there was a highly significant increase of incidence of in-hospital mortality [22].…”

Section: Discussionsupporting

confidence: 81%

“…For MACE, in our study, MSI was the strongest predictor of inhospital MACE then ASI, TIMIrs, and EF. That was in agreement with Qing Shangguan et al [21], where multifactor analysis showed that, in addition to MSI or ASI, age was independent factor for the 7-day MACE, with the OR of MSI was higher than that of age (3.05 vs 1.07). These results indicated that the poorer outcome in the increased MSI groups is not because of the older age, as the older patients may have higher SBP and lower DBP and then had higher MSI.…”

Section: According To the Correlation Between Timirs Asi And Msisupporting

confidence: 80%

“…Coronary angiography and PPCI was performed by a 24-hours on-call interventional team, according to standard clinical practice from published guidelines. Coronary flow after revascularization, we used the Thrombolysis in Myocardial Infarction (TIMI) flow classification (TIMI 0, 1, 2, 3) [21]. Patients then were admitted to our CCU for at least 48 hours to continue anti-ischemic treatment and where an ECG was performed immediately after and 90 minutes after the PPCI to monitor ST segment resolution with chest pain resolution.…”

Section: Introductionmentioning

confidence: 99%

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Modified Shock Index as a Predictor of In-Hospital Outcome in Cases of ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

2016

JCCR

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Submit Manuscript | http://medcraveonline.com 8]. The concept of shock index, defined as the ratio of heart rate and systolic blood pressure, first introduced by Allgower et al, in 1967 as a simple and effective means for gauging the degree of hypovolemia in hemorrhagic and infectious shock states [9]. Subsequently, experimental and clinical studies demonstrated that SI was inversely related to physiologic parameters, such as cardiac index, stroke volume, left ventricular stroke work, and mean arterial pressure [10].A new index, modified shock index (MSI), is created by as the ratio of HR and mean arterial pressure (MAP). He noticed that SI uses only systolic blood pressure, but diastolic blood pressure (DBP) is also of undeniable importance when determining patient's clinical severity. Hence he incorporated diastolic blood pressure and developed the modified shock index (MSI) [16]. Subjects and MethodsThis study was carried prospectively and included 216 patients who presented to CCU of Cardiology department, Zagazig university hospitals with acute STEMI who were treated with PPCI (from 1/2014 until 8/2016), with A time window for doing PPCI of 12 hours from onset of maximum chest pain. Extended time window to 18 hours from onset of maximum chest pain was used for patients presented with cardiogenic shock. We excluded the patients who, received fibrinolytic therapy, presented more than 12 hours from the onset of chest pain except for whom presented with cardiogenic shock, died at ER or before doing PPCI and presented by acute hemorrhage, acute hypovolemia, severe sepsis, severe trauma, or suspicion of pulmonary embolism.Patients who met the inclusion criteria were subjected to thorough history taking, Physical examination with special emphasis on both Blood pressure and pulse that were measured accurately in the supine position with >2 readings were taken with 1 min interval, and averaged. Admission SI was calculated for every patient that equals (admission HR/ admission SBP). Modified Admission SI was calculated for every patient that equals (admission HR/ mean admission BP, here MBP= [(DBPx2) +SBP]/3). The optimal cut-off values of SI, and MSI were based on optimizing the sum of sensitivity and specificity by receiver operating characteristic curve analysis, which predicted inhospital major adverse cardiovascular events.The patients were divided into 4 groups: The TIMI risk score was calculated for each patient using the variables obtained at admission according to the published criteria [5]. Killip's classification, Chest examination: with emphasis on detecting pulmonary edema or presence of pulmonary congestion, Cardiac examination: with emphasis on detecting murmurs Volume 7 Issue 4 -2016

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 81%

Section: According To the Correlation Between Timirs Asi And Msisupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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Modified Shock Index as a Predictor of In-Hospital Outcome in Cases of ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

2016

JCCR

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“…35 However, to the best of our knowledge, only one small (n=160), retrospective study compared the shock index with the modified shock index for the short-term prediction of a combined clinical endpoint (all-cause mortality, life-threatening arrhythmias, cardiogenic shock, and heart failure) in patients after STEMI. 36 The authors of this study found that both the shock index and the modified shock index were independent predictors of MACE, but the odds ratio of the modified shock index was numerically higher than that of the shock index. In our analysis, we observed no difference in the predictive value for MACE of the shock index and the modified shock index.…”

Section: Shock Index Vs Modified Shock Indexmentioning

confidence: 99%

Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction

Reinstadler

Fuernau

Eitel

et al. 2016

Circ J

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Background: Data on the prognostic value of the shock index in patients with ST-elevation myocardial infarction (STEMI) are scarce. Furthermore, the relationship of the shock index with myocardial damage is unknown. The aim of this study was to evaluate the association of the shock index with markers of myocardial damage and clinical outcome in patients with STEMI. Methods and Results:This multicenter study analyzed 791 patients. Patients were categorized in 2 groups according to the admission shock index (optimized cut-off=0.62). Infarct severity was determined by cardiac magnetic resonance (CMR) imaging. Patients with cardiogenic shock that were unable to undergo CMR acquisition were excluded. Major adverse cardiac events (MACE) were defined as a composite of death, reinfarction and congestive heart failure within 12 months. Patients with elevated admission shock index (n=321 [40.6%]) had a significantly larger area-at-risk (37. Conclusions: STEMI patients with an elevated admission shock index had more pronounced myocardial and microvascular damage. Moreover, the shock index was independently associated with MACE at 12 months. (Circ J 2016; 80: 924 -930)

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Ratio of systolic blood pressure to left ventricular end‐diastolic pressure at the time of primary percutaneous coronary intervention predicts in‐hospital mortality in patients with ST‐elevation myocardial infarction

Sola

Venkatesh

Caughey

et al. 2017

Cathet Cardio Intervent

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Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Cited by 53 publications

References 22 publications

Modified Shock Index as a Predictor of In-Hospital Outcome in Cases of ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Modified Shock Index as a Predictor of In-Hospital Outcome in Cases of ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction

Ratio of systolic blood pressure to left ventricular end‐diastolic pressure at the time of primary percutaneous coronary intervention predicts in‐hospital mortality in patients with ST‐elevation myocardial infarction

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