Jeong Joo Hee, Kook Hyungdon, Lee Seung Hun, Joo Hyung Joon, Park Jae Hyoung, Hong Soon Jun, Kim Mi-Na, Park Seong-Mi, Jung Jae Seung, Yang Jeong Hoon, Gwon Hyeon-Cheol, Ahn Chul-Min, Jang Woo Jin, Kim Hyun-Joong, Bae Jang-Whan, Kwon Sung Uk, Lee Wang Soo, Jeong Jin-Ok, Park Sang-Don, Lim Seong-Hoon, Lee Jiyoon, Lee Juneyoung, Yu Cheol Woong
Division of Cardiology, Department of Internal Medicine, Anam Hospital Korea University College of Medicine Seoul Korea.
Division of Cardiology, Department of Internal Medicine, College of Medicine Hanyang University Seoul Korea.
J Am Heart Assoc. 2024 Feb 20;13(4):e032701. doi: 10.1161/JAHA.123.032701. Epub 2024 Feb 16.
Clinical outcome of ischemic cardiogenic shock (CS) requiring extracorporeal membrane oxygenation is highly variable, necessitating appropriate assessment of prognosis. However, a systemic predictive model estimating the mortality of refractory ischemic CS is lacking. The PRECISE (Prediction of In-Hospital Mortality for Patients With Refractory Ischemic Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation Support) score was developed to predict the prognosis of refractory ischemic CS due to acute myocardial infarction.
Data were obtained from the multicenter CS registry RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With Cardiogenic Shock) that consists of 322 patients with acute myocardial infarction complicated by refractory ischemic CS requiring extracorporeal membrane oxygenation support. Fifteen parameters were selected to assess in-hospital mortality. The developed model was validated internally and externally using an independent external cohort (n=138). Among 322 patients, 138 (42.9%) survived postdischarge. Fifteen predictors were included for model development: age, diastolic blood pressure, hypertension, chronic kidney disease, peak lactic acid, serum creatinine, lowest left ventricular ejection fraction, vasoactive inotropic score, shock to extracorporeal membrane oxygenation insertion time, extracorporeal cardiopulmonary resuscitation, use of intra-aortic balloon pump, continuous renal replacement therapy, mechanical ventilator, successful coronary revascularization, and staged percutaneous coronary intervention. The PRECISE score yielded a high area under the receiver-operating characteristic curve (0.894 [95% CI, 0.860-0.927]). External validation and calibration resulted in competent sensitivity (area under the receiver-operating characteristic curve, 0.895 [95% CI, 0.853-0.930]).
The PRECISE score demonstrated high predictive performance and directly translates into the expected in-hospital mortality rate. The PRECISE score may be used to support clinical decision-making in ischemic CS (www.theprecisescore.com).
URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008.
需要体外膜肺氧合的缺血性心源性休克（CS）的临床结局差异很大，因此需要对预后进行适当评估。然而，目前缺乏一个系统性的预测模型来估计难治性缺血性CS的死亡率。PRECISE（预测需要静脉-动脉体外膜肺氧合支持的难治性缺血性心源性休克患者的院内死亡率）评分系统旨在预测急性心肌梗死所致难治性缺血性CS的预后。
数据来源于多中心CS注册研究RESCUE（一项调查韩国心源性休克患者左心室辅助装置临床结局和疗效的回顾性和前瞻性观察研究），该研究纳入了322例急性心肌梗死合并难治性缺血性CS且需要体外膜肺氧合支持的患者。选取了15项参数来评估院内死亡率。所建立的模型在内部和外部使用一个独立的外部队列（n = 138）进行了验证。在322例患者中，138例（42.9%）出院后存活。模型构建纳入了15个预测因子：年龄、舒张压、高血压、慢性肾脏病、乳酸峰值、血清肌酐、最低左心室射血分数、血管活性药物评分、休克至体外膜肺氧合植入时间、体外心肺复苏、主动脉内球囊泵的使用、持续肾脏替代治疗、机械通气、成功的冠状动脉血运重建以及分期经皮冠状动脉介入治疗。PRECISE评分在受试者工作特征曲线下的面积较高（0.894 [95% CI，0.860 - 0.927]）。外部验证和校准得到了较好的灵敏度（受试者工作特征曲线下的面积，0.895 [95% CI，0.853 - 0.930]）。
PRECISE评分显示出较高的预测性能，并且能直接转化为预期的院内死亡率。PRECISE评分可用于支持缺血性CS的临床决策（www.theprecisescore.com）。
