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Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort treated with pharmacoinvasive strategy.
Open Heart 2019; 6(2):e001069OH

Abstract

Objective

To validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with pharmacoinvasive strategy (PhIS) and to analyse the influence of ischaemia time on different risk strata.

Methods

We analysed 2143 patients with STEMI who underwent reperfusion with tenecteplase in primary health services between May 2010 and April 2017 and were transferred to a tertiary hospital for cardiac catheterisation and continuity of care. Those who evolved to cardiogenic shock were scored as low (0-2), moderate (3-4) or high (5-9) risk of death in 30 days and pairwise-log-rank test was used to compare strata. Time intervals between symptoms onset and lytic (pain-to-needle) and fibrinolytic-catheterisation were also compared.

Results

Cardiogenic shock occurred in 212 (9.9%) individuals. The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62) and 76% for high-risk (n=25) analysed patients (p<0.001). Validation of the score showed good discrimination for death, area under the curve of 0.73 (CI: 0.66 to 0.81; p<0.001). The median intervals of pain-to-needle and fibrinolytic-catheterisation showed no association with the group stratification (220 vs 251 vs 200 min; p=0.22 and 390 vs 435 vs 315 min; p=0.18, respectively).

Conclusions

In patients with cardiogenic shock after STEMI treated with PhIS, risk stratification using IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterisation times on the ability to the score model stratification.

Authors+Show Affiliations

Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.Department of Cardiology, Hospital do Servidor Público Municipal, Sao Paulo, Brazil.Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil. Department of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31413846

Citation

Moraes, Pedro Ivo M., et al. "Cardiogenic Shock After ST Elevation Myocardial Infarction and IABP-SHOCK II Risk Score Validation in a Cohort Treated With Pharmacoinvasive Strategy." Open Heart, vol. 6, no. 2, 2019, pp. e001069.
Moraes PIM, Alves CR, Souza MT, et al. Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort treated with pharmacoinvasive strategy. Open Heart. 2019;6(2):e001069.
Moraes, P. I. M., Alves, C. R., Souza, M. T., Kawakami, S. E., Goncalves, I., Barbosa, A. H. P., ... Carvalho, A. C. (2019). Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort treated with pharmacoinvasive strategy. Open Heart, 6(2), pp. e001069. doi:10.1136/openhrt-2019-001069.
Moraes PIM, et al. Cardiogenic Shock After ST Elevation Myocardial Infarction and IABP-SHOCK II Risk Score Validation in a Cohort Treated With Pharmacoinvasive Strategy. Open Heart. 2019;6(2):e001069. PubMed PMID: 31413846.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort treated with pharmacoinvasive strategy. AU - Moraes,Pedro Ivo M, AU - Alves,Claudia Rodrigues, AU - Souza,Marco Tulio, AU - Kawakami,Suzi Emiko, AU - Goncalves,Iran,Jr AU - Barbosa,Adriano Henrique Pereira, AU - Moreno,Antonio Celio, AU - Caixeta,Adriano Mendes, AU - Carvalho,Antonio Carlos, Y1 - 2019/07/29/ PY - 2019/04/18/received PY - 2019/06/12/revised PY - 2019/07/04/accepted PY - 2019/8/16/entrez PY - 2019/8/16/pubmed PY - 2019/8/16/medline KW - STEMI KW - cardiogenic shock KW - reperfusion KW - risk stratification KW - thrombolytic therapy SP - e001069 EP - e001069 JF - Open heart JO - Open Heart VL - 6 IS - 2 N2 - Objective: To validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with pharmacoinvasive strategy (PhIS) and to analyse the influence of ischaemia time on different risk strata. Methods: We analysed 2143 patients with STEMI who underwent reperfusion with tenecteplase in primary health services between May 2010 and April 2017 and were transferred to a tertiary hospital for cardiac catheterisation and continuity of care. Those who evolved to cardiogenic shock were scored as low (0-2), moderate (3-4) or high (5-9) risk of death in 30 days and pairwise-log-rank test was used to compare strata. Time intervals between symptoms onset and lytic (pain-to-needle) and fibrinolytic-catheterisation were also compared. Results: Cardiogenic shock occurred in 212 (9.9%) individuals. The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62) and 76% for high-risk (n=25) analysed patients (p<0.001). Validation of the score showed good discrimination for death, area under the curve of 0.73 (CI: 0.66 to 0.81; p<0.001). The median intervals of pain-to-needle and fibrinolytic-catheterisation showed no association with the group stratification (220 vs 251 vs 200 min; p=0.22 and 390 vs 435 vs 315 min; p=0.18, respectively). Conclusions: In patients with cardiogenic shock after STEMI treated with PhIS, risk stratification using IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterisation times on the ability to the score model stratification. SN - 2053-3624 UR - https://www.unboundmedicine.com/medline/citation/31413846/Cardiogenic_shock_after_ST_elevation_myocardial_infarction_and_IABP-SHOCK_II_risk_score_validation_in_a_cohort_treated_with_pharmacoinvasive_strategy L2 - http://dx.doi.org/10.1136/openhrt-2019-001069 DB - PRIME DP - Unbound Medicine ER -