Peters Elma J, Kunkel Joakim B, Bogerd Margriet, Ten Berg Sanne, Timmermans Marijke J C, Helgestad Ole K L, Ravn Hanne B, Kraaijeveld Adriaan O, Otterspoor Luuk C, Sjauw Krischan D, Lipšic Erik, Engström Annemarie E, Vlaar Alexander P J, Hassager Christian, Møller Jacob E, Henriques José P S
Department of Cardiology, Heart Center, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Eur Heart J Acute Cardiovasc Care. 2025 Mar 25. doi: 10.1093/ehjacc/zuaf043.
Mortality in patients with acute myocardial infarction-related cardiogenic shock (AMICS) is high, but a widely accepted tool for individual risk assessment is lacking. A reliable prediction model could assist in clinical decision making, patient selection for clinical trials, and comparison of AMICS populations. Therefore, the aim of this study was to develop and externally validate a prediction model for 30-day mortality in AMICS patients.
This retrospective cohort study included patients from 2017 to 2021(development cohort) and 2010-2017 (validation cohort). Patients with AMICS undergoing percutaneous coronary intervention in the Netherlands were identified using the Netherlands Heart Registration. International validation was performed in the Danish Retroshock registry. The main outcome was 30-day mortality.
Among 2261 patients, the median age was 67 years(IQR 58-75), and 1649(73%) were male. The mortality rate at 30 days was 39%(n=886). Significant predictors for mortality were: initial lactate, glucose, renal function, hemoglobin, age, blood pressure, heart rate, intubation prior to PCI, intervention in the left main coronary artery, and successful revascularization. The AUC of the initial model was 0.81(0.79-0.83). The external validation cohort included 1393 patients with 1050 (75%) male and a median age of 67 years(IQR 59-75). The 30-day mortality rate was 49%(n=680). The model showed good performance om the external validation with an AUC of 0.73(0.70-0.76).
A prediction model was developed and externally validated using data from two large national registries. The model demonstrated good performance and is suitable for clinical decision-making and quality purposes in AMICS.
急性心肌梗死相关心源性休克（AMICS）患者的死亡率很高，但缺乏一种被广泛接受的个体风险评估工具。可靠的预测模型有助于临床决策、临床试验的患者选择以及AMICS人群的比较。因此，本研究的目的是开发并外部验证AMICS患者30天死亡率的预测模型。
这项回顾性队列研究纳入了2017年至2021年（开发队列）和2010年至2017年（验证队列）的患者。使用荷兰心脏登记系统识别在荷兰接受经皮冠状动脉介入治疗的AMICS患者。在丹麦Retroshock登记系统中进行国际验证。主要结局是30天死亡率。
在2261例患者中，中位年龄为67岁（四分位间距58 - 75岁），1649例（73%）为男性。30天死亡率为39%（n = 886）。死亡率的显著预测因素为：初始乳酸、血糖、肾功能、血红蛋白、年龄、血压、心率、PCI术前插管、左主干冠状动脉介入治疗以及成功的血运重建。初始模型的AUC为0.81（0.79 - 0.83）。外部验证队列包括1393例患者，其中1050例（75%）为男性，中位年龄为67岁（四分位间距59 - 75岁）。30天死亡率为49%（n = 680）。该模型在外部验证中表现良好，AUC为0.73（0.70 - 0.76）。
使用来自两个大型国家登记系统的数据开发并外部验证了一个预测模型。该模型表现良好，适用于AMICS的临床决策和质量评估。
