title: A simple risk chart for initial risk assessment of 30-day mortality in patients with cardiogenic shock from ST-elevation myocardial infarction.
abstract: OBJECTIVE
  Early risk stratification is important in patients with cardiogenic shock from ST-elevation myocardial infarction (STEMI). We aimed to develop a simple risk chart that includes clinical parameters that are readily available at time of hospital admission to assess risk of 30-day mortality.
  
  
  RESULTS
  A series of 544 STEMI patients admitted to undergo primary percutaneous coronary intervention and presenting with cardiogenic shock were included between 2000 and 2012. Overall 30-day mortality was 38.4% and did not change over the years (p-trend=0.64). Baseline variables that were available at time of hospital admission were entered into a logistic regression model in a forward stepwise manner. Only age (odds ratio (OR) per year 1.05, 95% confidence interval (CI) 1.04-1.07, p<0.001), initial serum lactate level (OR per mmol/l 1.17, 95% CI 1.11-1.24, p<0.001) and initial creatinine level above the upper limit of normal (OR 2.89, 95% CI 1.90-4.37, p<0.001) remained independent predictors, and were subsequently used to develop a risk chart that stratifies risk of 30-day mortality into categories ranging from 0-20% to 80-100%. The calibration plot showed a close relationship between expected and observed mortality. The risk chart had a higher discriminative accuracy than the GRACE score (c-index 0.75 vs. 0.66, p=0.009). Adding variables that were obtained from coronary angiography and during clinical course did not significantly improve discriminative accuracy of risk chart (c-index 0.77, p=0.48).
  
  
  CONCLUSIONS
  Mortality of patients with cardiogenic shock from STEMI undergoing primary percutaneous coronary intervention can be well predicted already at time of hospital admission by a risk chart that uses only three variables, namely, age, initial serum lactate and creatinine level.
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands j.cheng@erasmusmc.nl.
authors.forename: Jin M
authors.initials: JM
authors.lastname: Cheng
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: Anne Mijn
authors.initials: AM
authors.lastname: Helming
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: Laura C
authors.initials: LC
authors.lastname: van Vark
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: Isabella
authors.initials: I
authors.lastname: Kardys
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: Corstiaan A
authors.initials: CA
authors.lastname: Den Uil
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: Lucia S D
authors.initials: LS
authors.lastname: Jewbali
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.affiliation: Erasmus MC, Department of Cardiology, Rotterdam, The Netherlands.
authors.forename: K Martijn
authors.initials: KM
authors.lastname: Akkerhuis
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D009426:Netherlands / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality* / Q000601:surgery; D016896:Treatment Outcome
keywords: Cardiogenic shock; mortality; myocardial infarction; predictors; risk score