Introduction
In a high-severity scenario such as cardiogenic shock after acute ST elevation myocardial infarction (STEMI), hospital mortality rates reach 50%, even after adequate reperfusion.1–3 Immediate risk stratification offers important prognostic information and may direct the selection of patients for advanced therapies such as mechanical ventricular assistance and cardiac transplantation.4–9
Although primary percutaneous coronary intervention (PPCI) is the ideal strategy for reperfusion, the similarity between pharmacoinvasive strategy (PhIS) and PPCI has been recently demonstrated in patients without shock up to 3 hours after the onset of symptoms.10 Based on multiple data, PhIS has been considered a valuable and effective alternative in patients who cannot reach early access to a cardiac catheterisation laboratory and it was incorporated into guidelines.10–18 On the other hand, PhIS in cardiogenic shock has only recently been formally considered when PPCI is not available.18 In developing countries, PhIS to patients with cardiogenic shock has been applied more often and the analysis of this population may fill gaps of knowledge on this subject.
A new and simple risk score (table 1), derived from the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II Trial),19 was developed and validated for 30-day risk of death stratification in patients with cardiogenic shock secondary to STEMI who undergo PPCI. Several demographic characteristics and the metrics of STEMI care differentiate patients receiving PPCI or PhIS.20 21
This study aimed to validate the IABP-SHOCK II score in a cohort of patients with cardiogenic shock secondary to STEMI treated according to a PhIS and examined the influence of ischaemia time on the different risk strata.