You are here

  • Home
  • Archive
  • Volume 6, Issue 2
  • Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort treated with pharmacoinvasive strategy

Article Text

Article menu

Download PDFPDF

XML
Coronary artery disease
Original research
Cardiogenic shock after ST elevation myocardial infarction and IABP-SHOCK II risk score validation in a cohort treated with pharmacoinvasive strategy
  1. Pedro Ivo M Moraes1,
  2. Claudia Rodrigues Alves1,
  3. Marco Tulio Souza1,
  4. Suzi Emiko Kawakami1,
  5. Iran Goncalves Jr1,
  6. Adriano Henrique Pereira Barbosa1,
  7. Antonio Celio Moreno2,
  8. Adriano Mendes Caixeta1,3 and
  9. Antonio Carlos Carvalho1
  1. 1 Discipline of Cardiology - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
  2. 2 Department of Cardiology, Hospital do Servidor Público Municipal, Sao Paulo, Brazil
  3. 3 Department of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  1. Correspondence to Dr Pedro Ivo M Moraes; pedroivo_mm{at}hotmail.com

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.

  • cardiogenic shock
  • STEMI
  • reperfusion
  • thrombolytic therapy
  • risk stratification

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2019-001069

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors ACC and PIM conceived of the presented idea. PIM and CRA developed the theory and performed the computations. MTS, SEK, AMC, AHPB, IGJ and ACM contributed to data collect and a critical review of the abstract. All authors discussed the results and contributed to the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.