Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstr. 39, D-04289 Leipzig, Germany.
Leipzig Heart Institute, Leipzig, Germany.
Eur Heart J Acute Cardiovasc Care. 2021 Oct 27;10(8):890-897. doi: 10.1093/ehjacc/zuab054.
Several prediction models have been developed to allow accurate risk assessment and provide better treatment guidance in patients with infarct-related cardiogenic shock (CS). However, comparative data between these models are still scarce. The objective of the study is to externally validate different risk prediction models in infarct-related CS and compare their predictive value in the early clinical course.
The Simplified Acute Physiology Score (SAPS) II Score, the CardShock score, the IABP-SHOCK II score, and the Society for Cardiovascular Angiography and Intervention (SCAI) classification were each externally validated in a total of 1055 patients with infarct-related CS enrolled into the randomized CULPRIT-SHOCK trial or the corresponding registry. The primary outcome was 30-day all-cause mortality. Discriminative power was assessed by comparing the area under the curves (AUC) in case of continuous scores. In direct comparison of the continuous scores in a total of 161 patients, the IABP-SHOCK II score revealed best discrimination [area under the curve (AUC = 0.74)], followed by the CardShock score (AUC = 0.69) and the SAPS II score, giving only moderate discrimination (AUC = 0.63). All of the three scores revealed acceptable calibration by Hosmer-Lemeshow test. The SCAI classification as a categorical predictive model displayed good prognostic assessment for the highest risk group (Stage E) but showed poor discrimination between Stages C and D with respect to short-term-mortality.
Based on the present findings, the IABP-SHOCK II score appears to be the most suitable of the examined models for immediate risk prediction in infarct-related CS. Prospective evaluation of the models, further modification, or even development of new scores might be necessary to reach higher levels of discrimination.
已经开发出几种预测模型，以允许对梗死相关心源性休克（CS）患者进行准确的风险评估并提供更好的治疗指导。然而，这些模型之间的比较数据仍然很少。本研究的目的是在外验证不同的梗死相关 CS 风险预测模型，并比较它们在早期临床过程中的预测价值。
共有 1055 例梗死相关 CS 患者被纳入随机 CULPRIT-SHOCK 试验或相应的登记处，分别对外验证简化急性生理学评分（SAPS）II 评分、CardShock 评分、IABP-SHOCK II 评分和心血管造影和介入学会（SCAI）分类。主要结局是 30 天全因死亡率。通过比较连续评分的曲线下面积（AUC）来评估判别能力。在总共 161 例患者的连续评分的直接比较中，IABP-SHOCK II 评分显示出最佳的判别能力[AUC（曲线下面积）= 0.74]，其次是 CardShock 评分[AUC = 0.69]和 SAPS II 评分，仅具有中等判别能力[AUC = 0.63]。Hosmer-Lemeshow 检验显示所有三种评分的校准均可以接受。作为分类预测模型的 SCAI 分类对最高风险组（E 期）显示出良好的预后评估，但在短期死亡率方面，对 C 期和 D 期之间的判别能力较差。
根据目前的发现，IABP-SHOCK II 评分似乎是梗死相关 CS 中最适合即时风险预测的模型。可能需要对模型进行前瞻性评估、进一步修改甚至开发新的评分，以达到更高的判别水平。
