Yang Jun-Qing, Ran Peng, Li Jie, Zhong Qi, Smith Sidney C, Wang Yan, Fonarow Gregg C, Qiu Jia, Morgan Louise, Wei Xue-Biao, Chen Xiao-Bo, Huang Jie-Leng, Hao Yong-Chen, Zhou Ying-Ling, Siu Chung-Wah, Zhao Dong, Chen Ji-Yan, Yu Dan-Qing
Guangdong Provincial Key Laboratory of Coronary Heart Disease, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States.
Front Cardiovasc Med. 2022 Mar 4;9:793497. doi: 10.3389/fcvm.2022.793497. eCollection 2022.
Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) despite advances in care. This study aims to derive and validate a risk score for in-hospital development of CS in patients with AMI.
In this study, we used the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) registry of 76,807 patients for model development and internal validation. These patients came from 158 tertiary hospitals and 82 secondary hospitals between 2014 and 2019, presenting AMI without CS upon admission. The eligible patients with AMI were randomly assigned to derivation ( = 53,790) and internal validation ( = 23,017) cohorts. Another cohort of 2,205 patients with AMI between 2014 and 2016 was used for external validation. Based on the identified predictors for in-hospital CS, a new point-based CS risk scheme, referred to as the CCC-ACS CS score, was developed and validated.
A total of 866 (1.1%) and 39 (1.8%) patients subsequently developed in-hospital CS in the CCC-ACS project and external validation cohort, respectively. The CCC-ACS CS score consists of seven variables, including age, acute heart failure upon admission, systolic blood pressure upon admission, heart rate, initial serum creatine kinase-MB level, estimated glomerular filtration rate, and mechanical complications. The area under the curve for in-hospital development of CS was 0.73, 0.71, and 0.85 in the derivation, internal validation and external validation cohorts, respectively.
This newly developed CCC-ACS CS score can quantify the risk of in-hospital CS for patients with AMI, which may help in clinical decision making.
www.ClinicalTrials.gov, identifier: NCT02306616.
尽管在治疗方面取得了进展，但心源性休克（CS）仍是急性心肌梗死（AMI）患者死亡的主要原因。本研究旨在推导并验证AMI患者院内发生CS的风险评分。
在本研究中，我们使用了中国心血管疾病改善计划-急性冠状动脉综合征（CCC-ACS）登记库中的76807例患者进行模型开发和内部验证。这些患者来自2014年至2019年间的158家三级医院和82家二级医院，入院时表现为AMI且无CS。符合条件的AMI患者被随机分配到推导队列（n = 53790）和内部验证队列（n = 23017）。另一组由2014年至2016年间的2205例AMI患者组成的队列用于外部验证。基于确定的院内CS预测因素，开发并验证了一种新的基于点数的CS风险方案，称为CCC-ACS CS评分。
在CCC-ACS项目队列和外部验证队列中，分别有866例（1.1%）和39例（1.8%）患者随后发生了院内CS。CCC-ACS CS评分由七个变量组成，包括年龄、入院时急性心力衰竭、入院时收缩压、心率、初始血清肌酸激酶-MB水平、估计肾小球滤过率和机械并发症。推导队列、内部验证队列和外部验证队列中院内发生CS的曲线下面积分别为0.73、0.71和0.85。
新开发的CCC-ACS CS评分可以量化AMI患者院内发生CS的风险，这可能有助于临床决策。
