Poess, Janine; Koester, Jelena; Fuernau, Georg; Eitel, Ingo; de Waha, Suzanne; Ouarrak, Taoufik; Lassus, Johan; Harjola, Veli-Pekka; Zeymer, Uwe; Thiele, Holger; Desch, Steffen
(2017)
BACKGROUND Mortality in cardiogenic shock (CS) remains high. Early risk stratification is crucial to make adequate treatment decisions. OBJECTIVES This study sought to develop an easy-to-use, readily available risk prediction score for short-term mortality in patients with CS, derived from the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock) trial. METHODS The score was developed using a stepwise multivariable regression analysis. RESULTS Six variables emerged as independent predictors for 30-day mortality and were used as score parameters: age > 73 years, prior stroke, glucose at admission >10.6 mmol/l (191 mg/dl), creatinine at admission >132.6 mmol/l (1.5 mg/dl), Thrombolysis In Myocardial Infarction flow grade 5 mmol/l. Either 1 or 2 points were attributed to each variable, leading to a score in 3 risk categories: low (0 to 2), intermediate (3 or 4), and high (5 to 9). The observed 30-day mortality rates were 23.8%, 49.2%, and 76.6%, respectively (p <0.0001). Validation in the IABP-SHOCK II registry population showed good discrimination with an area under the curve of 0.79. External validation in the CardShock trial population (n = 137) showed short-term mortality rates of 28.0% (score 0 to 2), 42.9% (score 3 to 4), and 77.3% (score 5 to 9; p <0.001) and an area under the curve of 0.73. Kaplan-Meier analysis revealed a stepwise increase in mortality between the different score categories (0 to 2 vs. 3 to 4: p = 0.04; 0 to 2 vs. 5 to 9: p = 0.008). CONCLUSIONS The IABP-SHOCK II risk score can be easily calculated in daily clinical practice and strongly correlated with mortality in patients with infarct-related CS. It may help stratify patient risk for short-term mortality and might, thus, facilitate clinical decision making. (Intraaortic Balloon Pump in Cardiogenic Shock II [ IABP-SHOCK II]; NCT00491036) (J Am Coll Cardiol 2017; 69: 1913-20) (C) 2017 by the American College of Cardiology Foundation.