Usefulness of the Admission Shock Index for Predicting Short-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction

Huang, Bi; Yang, Yanmin; Zhu, Jun; Liang, Yan; Tan, Huiqiong; Yu, Litian; Gào, Xīn; Li, Jian Dong

doi:10.1016/j.amjcard.2014.07.062

Cited by 58 publications

(87 citation statements)

References 26 publications

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“…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].…”

Section: Discussionsupporting

confidence: 82%

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%

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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“…9 Moreover, the exclusion of all patients with cardiac arrhythmias on admission (6%) did not significantly change the association of the shock index with MACE (data not shown).…”

Section: Baseline Patient Characteristicsmentioning

confidence: 99%

“…These findings were the same when considering the 0.7 cut-off for shock index according to the literature. 9 The shock index on admission was a significant predictor of infarct size in multivariate regression analysis (β=0.11, P=0.001). Further significant predictors of infarct size were pain-to-balloon time, number of diseased vessels, infarct-related artery, Killip-class on admission, and TIMI-flow before PPCI (all P<0.05).…”

Section: Shock Index and Clinical Outcomementioning

confidence: 99%

“…9 The only study investigating the prognostic significance of the shock index after a longer follow-up period (approximately 15 months) observed that patients with an elevated shock index were at a higher risk of death. 10 Our multicenter study reflecting contemporary PPCI practice complements and extends these previous findings by showing that the admission shock index is strongly related to the occurrence of MACE at 12 months after STEMI.…”

Section: Conflicts Of Interestsmentioning

confidence: 99%

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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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“…In addition, high SI has been reported to have prognostic significance in trauma3 and acute cardiovascular events such as acute myocardial infarction and stroke 4, 5, 6. Although heart rate and BP are important variables in predicting acute stroke outcome, physiologically they are linked to each other.…”

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confidence: 99%

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Myint

Sheng

Xian

et al. 2018

JAHA

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BackgroundThe prognostic value of shock index (SI), heart rate divided by systolic blood pressure, in stroke for clinical outcomes other than mortality is not well understood.Methods and ResultsWe examined the Get With The Guidelines–Stroke (GWTG‐Stroke) data to explore the usefulness of SI in predicting in‐hospital outcomes in 425 808 acute stroke cases (mean age: 71.0±14.5 years; 48.8% male; 89.7% ischemic stroke and 10.3% intracerebral hemorrhage) admitted between October 2012 and March 2015. Compared with patients with SI of 0.5 to 0.7, patients with SI >0.7 (13.6% of the sample) had worse outcomes, with adjusted odds ratios of 2.00 (95% confidence interval [CI], 1.92–2.08) for in‐hospital mortality, 1.46 (95% CI, 1.43–1.49) for longer length of hospital stay >4 days, 1.50 (95% CI, 1.47–1.54) for discharge destination other than home, 1.41 (95% CI, 1.38–1.45) for inability to ambulate independently at discharge, and 1.52 (95% CI, 1.47–1.57) for modified Rankin Scale score of 3 to 6 at discharge. Results were similar when analyses were confined to those with available National Institutes of Health Stroke Scale (NIHSS) or within individual stroke subtypes or when SI was additionally included in the models with or without blood pressure components. Every 0.1 increase in SI >0.5 was associated with significantly worse outcomes in linear spline models. The addition of SI to existing GWTG‐Stroke mortality prediction models without NIHSS demonstrated modest improvement, but little to no improvement was noted in models with NIHSS.Conclusions SI calculated at the point of care may be a useful prognostic indicator to identify those with high risk of poor outcomes in acute stroke, especially in hospitals with limited experience with NIHSS assessment.

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Usefulness of the Admission Shock Index for Predicting Short-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction

Cited by 58 publications

References 26 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

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

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