title: A New Risk Score to Predict Long-Term Cardiac Mortality in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock and Treated With Primary Percutaneous Intervention.
abstract: Poor data exist about predictors of long-term cardiac mortality in patients presenting acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) treated with primary percutaneous coronary intervention (p-PCI), and current risk-adjustment models in this setting are not adequate. We retrospectively analyzed our registry of patients with AMI treated with p-PCI. The aim of this study was to identify the independent predictors of 2-year cardiac mortality in patients presenting CS. A Risk Score was created assigning at any independent variable a value directly correlated with its power to increase mortality. From 1995 to 2013, 4,078 consecutive patients underwent primary PCI for AMI. Of these, 388 patients (10.5%) had CS on admission. The p-PCI procedural success was 85%. At 2-year follow-up, the overall cardiac mortality rate was 48%. The independent predictors related with mortality were: out of hospital cardiac arrest (OHCA) (hazard ratio [HR] 1.51; p = 0.04), age >75 years (HR 2.09; p ≤0.001), and failure p-PCI (HR 2.30; p <0.001). On the basis of the HR obtained, we assigned an incremental value to each independent variable identified (OHCA: 0.5 points, age>75 years: 1 point, failed p-PCI: 1.5 points). The mortality rates among different score risk level were highly significant (p <0.001): 32% score risk 1 (points 0), 58% score risk 2 (points 0.5-2), and 83% score risk 3 (points >2), respectively. In conclusion, OHCA, age >75 years, and failed p-PCI are strong predictors of 2-year cardiac mortality. On the basis of this, a rapid score tool could be useful to identify patients at major risk of death.
authors.affiliation: Division of Cardiology, Careggi-Hospital, Florence, Italy. Electronic address: ruben.arg@gmail.com.
authors.forename: Ruben
authors.initials: R
authors.lastname: Vergara
authors.affiliation: Division of Cardiology, Careggi-Hospital, Florence, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.affiliation: Division of Cardiology, Careggi-Hospital, Florence, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.affiliation: Division of Cardiology, Careggi-Hospital, Florence, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Cerisano
authors.affiliation: Division of Cardiology, Careggi-Hospital, Florence, Italy.
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.affiliation: Division of Cardiology, Careggi-Hospital, Florence, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Giurlani
authors.affiliation: Division of Cardiology, Careggi-Hospital, Florence, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery*; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology*; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery*; D017211:Treatment Failure