title: Shock Index More Sensitive Than Cardiogenic Shock in ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention.
abstract: Cardiogenic shock (CS) is a strong predictor of mortality in patients with ST-elevation myocardial infarction (STEMI), but there is evidence that shock index (SI), taking into account both blood pressure and heart rate, is a more sensitive and powerful predictor. We investigated the independent impact of SI and CS on 30-day and 1-year mortality in patients with STEMI, treated by primary percutaneous coronary intervention (PCI).
  
  
  
  In 7,412 consecutive patients with STEMI treated with primary PCI, the predictive value of either SI or CS on 1-year mortality was assessed. Best cut-off value of SI, determined using receiver operating characteristic (ROC) curve, was 0.7, with an ROC AUC of 0.66 (95% CI: 0.65-0.67), compared with an ROC AUC of 0.60 (95% CI: 0.59-0.61) for CS (P<0.001). At admission, 387 patients (5.2%) had CS and 1,567 patients (21.1%) had SI ≥0.7. The adjusted hazard ratio of mortality in patients with SI ≥0.7 and in CS patients was, respectively, 3.3 (95% CI: 2.4-4.6) and 3.1 (95% CI: 2.1-4.6) after 30 days, and 2.3 (95% CI: 1.8-2.9) and 3.1 (95% CI: 2.2-4.2) after 1 year.
  
  
  
  SI identifies more patients with increased risk of mortality, and seems to be a more sensitive prognostic predictor than CS in patients with STEMI treated by primary PCI.
authors.affiliation: Department of Cardiology, Isala Heart Centre.
authors.forename: Veemal V
authors.initials: VV
authors.lastname: Hemradj
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: Menko Jan
authors.initials: MJ
authors.lastname: de Boer
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D012372:ROC Curve; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000401:mortality*