Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score

Auffret, Vincent; Cottin, Yves; Leurent, Guillaume; Gilard, Martine; Beer, Jean‐Claude; Zabalawi, A.; Chagué, F.; Filippi, Emanuelle; Brunet, Damien; Hacot, Jean-Philippe; Brunel, Philippe; Mejri, Mourad; Lorgis, Luc; Rouault, Gilles; Druelles, Philippes; Cornily, Jean-Christophe; Didier, Romain; Bot, Emilie; Boulanger, Bertrand; Coudert, Isabelle; Loirat, Aurélie; Bédossa, Marc; Boulmier, Dominique; Maza, M.; Guellec, Marielle Le; Puri, Rishi; Zeller, Marianne; Breton, Hervé; Orbi,

doi:10.1093/eurheartj/ehy127

Cited by 76 publications

(44 citation statements)

References 32 publications

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“…Interestingly, higher CRP levels, left bundle branch block or right bundle branch block on admission were associated with an increased risk of developing secondary CS. Predictors such as age, STEMI, CRP and out‐of‐hospital cardiac arrest but also bundle branch blocks on admission ECG might therefore be used to identify patients at high‐risk of developing CS during hospitalization following AMI . They may also facilitate pre‐emptive clinical decision making …”

Section: Discussionmentioning

confidence: 99%

Trends in cardiogenic shock complicating acute myocardial infarction

Aïssaoui

Puymirat

Delmas

et al. 2020

European J of Heart Fail

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Aims Few studies describe recent changes in the prevalence, management, and outcomes of cardiogenic shock (CS) patients complicating acute myocardial infarction (AMI) in the era of widespread use of invasive strategies. The aim of the present study was to analyse trends observed in CS complicating AMI over the past 10 years, focusing on the timing of CS occurrence (i.e. primary CS, CS on admission vs. secondary CS, CS developed subsequently during hospitalization). Methods and results Three nationwide French registries conducted and designed to evaluate AMI management and outcomes in ‘real‐life’ practice included consecutive AMI patients (n = 9951) admitted to intensive cardiovascular care units (ICCUs) over a 1‐month period, 5 years apart. The prevalence of CS complicating AMI decreased from 2005 to 2015: 5.9%, mean age 74.1 ± 12.7 in 2005; 4.0%, mean age 73.9 ± 12.7 in 2010, 2.8%, mean age 71.1 ± 15.0 in 2015 (P < 0.001). It decreased for both primary (1.8% to 1.0%) and secondary CS (4.1% to 1.8%). The profile of CS patients also changed over time with more patients presenting out‐of‐hospital cardiac arrest. In both primary and secondary CS, the use of percutaneous coronary intervention increased markedly over time, as did the use of mechanical ventilation and cardiac assist devices. Over the 10‐year period, in‐hospital mortality remained unchanged for both primary CS (41.8% to 37.8%) or secondary CS (57.3% to 58.8%). However, 1‐year mortality decreased in patients with primary CS (from 60% to 37.8%, P = 0.038), and remained unchanged in patients developing secondary CS (from 64.5% to 69.1%, P = 0.731). Conclusion Cardiogenic shock complicating AMI has become less frequent but, if present, CS, and particularly secondary CS, carries a very high mortality, which has not substantially improved over the past 10 years, in spite of the more frequent use of invasive strategies.

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Section: Discussionmentioning

confidence: 99%

Trends in cardiogenic shock complicating acute myocardial infarction

Aïssaoui

Puymirat

Delmas

et al. 2020

European J of Heart Fail

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“…Future studies are still warranted to confirm these promising findings. Finally, it is necessary to derive efficient risk scores for identifying patients at high risk of developing cardiogenic shock following AMI as this may aid in risk stratification and potential prophylactic utilization of MCS during PCI to mitigate subsequent hemodynamic derangement in this high-risk population [103].…”

Section: Future Directionsmentioning

confidence: 99%

Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Asleh

Resar

2019

JCM

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Given the tremendous progress in interventional cardiology over the last decade, a growing number of older patients, who have more comorbidities and more complex coronary artery disease, are being considered for technically challenging and high-risk percutaneous coronary interventions (PCI). The success of performing such complex PCI is increasingly dependent on the availability and improvement of mechanical circulatory support (MCS) devices, which aim to provide hemodynamic support and left ventricular (LV) unloading to enable safe and successful coronary revascularization. MCS as an adjunct to high-risk PCI may, therefore, be an important component for improvement in clinical outcomes. MCS devices in this setting can be used for two main clinical conditions: patients who present with cardiogenic shock complicating acute myocardial infarction (AMI) and those undergoing technically complex and high-risk PCI without having overt cardiogenic shock. The current article reviews the advancement in the use of various devices in both AMI complicated by cardiogenic shock and complex high-risk PCI, highlights the available hemodynamic and clinical data associated with the use of MCS devices, and presents suggestive management strategies focusing on appropriate patient selection and optimal timing and support to potentially increase the clinical benefit from utilizing these devices during PCI in this high-risk group of patients.

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“…ORBI score (35) was designed to assist prediction of the development of in-hospital CS in patients with ST-segment elevation MI treated with primary PCI. Eleven variables were independently associated with the development of in-hospital CS.…”

Section: Risk Stratification and Prognostic Modelsmentioning

confidence: 99%

Therapeutic Advances in the Management of Cardiogenic Shock

Chioncel

Collins

Ambrosy

et al. 2019

American Journal of Therapeutics

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Background: Cardiogenic shock (CS) is a life-threatening state of tissue hypoperfusion, associated to a very high risk of mortality, despite intensive monitoring and modern treatment modalities. Present review aims to describe the therapeutic advances in the management of CS. Areas of Uncertainty: Many uncertainties about CS management remain in clinical practice, and these relate to intensity of invasive monitoring, the type and timing of vasoactive therapies, the risk-benefit ratio of mechanical circulatory support (MCS) therapy and optimal ventilation mode. Furthermore, most of the data is coming from CS in setting of acute myocardial infarction (AMI), while for nonAMI-CS patients there are very few evidences for etiological or MCS therapies. Data Sources: The prospective multicentric acute heart failure registries that specifically presented characteristics of patients with CS, distinct to other phenotypes, were included in the present review. Relevant clinical trials investigating therapeutic strategies in post AMI-CS patients were added as source information. Several trials investigating vasoactive medications and metaanalysis providing information about benefits and risks of MCS were reviewed in the manuscript.

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Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score

Abstract: The ORBI risk score provides a readily useable and efficient tool to identify patients at high-risk of developing CS during hospitalization following STEMI, which may aid in further risk-stratification and thus potentially facilitate pre-emptive clinical decision making.

Cited by 76 publications

References 32 publications

Trends in cardiogenic shock complicating acute myocardial infarction

Trends in cardiogenic shock complicating acute myocardial infarction

Utilization of Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock Complicating Acute Myocardial Infarction and High-Risk Percutaneous Coronary Interventions

Therapeutic Advances in the Management of Cardiogenic Shock

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