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Eur Heart J. 2018 Jun 7;39(22):2090-2102. doi: 10.1093/eurheartj/ehy127.

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.

Author information

1
Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.
2
Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France.
3
Department of Cardiology, La Cavale Blanche University Hospital, Optimization of physiological Regulations, Science and Technical Training and ResearchUnit, Boulevard Tanguy Prigent, 29200 Brest, France.
4
Department of Cardiology, General Hospital Yves Le Foll, 10 Rue Marcel Proust, 22000 St-Brieuc, France.
5
Department of Cardiology, General Hospital of Atlantic Brittany, 20 Boulevard du Général Maurice Guillaudot, 56017 Vannes, France.
6
Department of Cardiology, Clinic of Fontaine, 1 Rue des Creots, 21121 Fontaine-lès-Dijon, France.
7
Department of Cardiology, General Hospital of South Brittany, 5 Avenue Choiseul, 56322 Lorient, France.
8
Department of Cardiology, General Hospital Broussais, St-Malo, 1 Rue de la Marne, 35403 France.
9
Department of Cardiology, General Hospital René Théophile Laennec, 14 bis Avenue Yves Thépot, 29107 Quimper, France.
10
Department of Cardiology, Clinic St-Laurent, 320 Avenue Général George S. Patton, 35700 Rennes, France.
11
Department of Cardiology, Clinic Keraudren-Grand Large, 375 Rue Ernestine de Trémaudan, 29220 Brest, France.
12
Department of Medical Emergency, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033 Rennes, France.
13
Department of Medical Emergency, General Hospital of Atlantic Brittany, 20 Boulevard du Général Maurice Guillaudot, 56017 Vannes, France.
14
Department of Medical Emergency, General Hospital Yves Le Foll, 10 Rue Marcel Proust, 22000 St-Brieuc, France.
15
EA 7460 Cerebro- and Cardiovascular Physiopathology and Epidemiology, University of Bourgogne-Franche Comté, 7 Boulevard Jeanne d'Arc, 21000 Dijon, France.

Abstract

Aims:

To derive and validate a readily useable risk score to identify patients at high-risk of in-hospital ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS).

Methods and results:

In all, 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire Régional Breton sur l'Infarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Côte-d'Or (RICO) constituted the external validation cohort. Stepwise multivariable logistic regression was used to build the score. Eleven variables were independently associated with the development of in-hospital CS: age >70 years, prior stroke/transient ischaemic attack, cardiac arrest upon admission, anterior STEMI, first medical contact-to-pPCI delay >90 min, Killip class, heart rate >90/min, a combination of systolic blood pressure <125 mmHg and pulse pressure <45 mmHg, glycaemia >10 mmol/L, culprit lesion of the left main coronary artery, and post-pPCI thrombolysis in myocardial infarction flow grade <3. The score derived from these variables allowed the classification of patients into four risk categories: low (0-7), low-to-intermediate (8-10), intermediate-to-high (11-12), and high (≥13). Observed in-hospital CS rates were 1.3%, 6.6%, 11.7%, and 31.8%, across the four risk categories, respectively. Validation in the RICO cohort demonstrated in-hospital CS rates of 3.1% (score 0-7), 10.6% (score 8-10), 18.1% (score 11-12), and 34.1% (score ≥13). The score demonstrated high discrimination (c-statistic of 0.84 in the derivation cohort, 0.80 in the validation cohort) and adequate calibration in both cohorts.

Conclusion:

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.

PMID:
29554243
DOI:
10.1093/eurheartj/ehy127

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