External validation and comparison of the CardShock and IABP-SHOCK II risk scores in real-world cardiogenic shock patients
Por:
Rivas-Lasarte, M, Sans-Rosello, J, Collado-Lledo, E, Garcia-Fernandez, V, Noriega, FJ, Hernandez-Perez, FJ, Fernandez-Martinez, J, Ariza, A, Lidon, RM, Viana-Tejedor, A, Segovia-Cubero, J, Harjola, VP, Lassus, J, Thiele, H, Sionis, A
Publicada:
1 ene 2021
Ahead of Print:
1 ene 2020
Resumen:
Background:
Mortality from cardiogenic shock remains high and early recognition and risk stratification are mandatory for optimal patient allocation and to guide treatment strategy. The CardShock and the Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock (IABP-SHOCK II) risk scores have shown good results in predicting short-term mortality in cardiogenic shock. However, to date, they have not been compared in a large cohort of ischaemic and non-ischaemic real-world cardiogenic shock patients.
Methods:
The Red-Shock is a multicentre cohort of non-selected cardiogenic shock patients. We calculated the CardShock and IABP-SHOCK II risk scores in each patient and assessed discrimination and calibration.
Results:
We included 696 patients. The main cause of cardiogenic shock was acute coronary syndrome, occurring in 62% of the patients. Compared with acute coronary syndrome patients, non-acute coronary syndrome patients were younger and had a lower proportion of risk factors but higher rates of renal insufficiency; intra-aortic balloon pump was also less frequently used (31% vs 56%). In contrast, non-acute coronary syndrome patients were more often treated with mechanical circulatory support devices (11% vs 3%, p<0.001 for both). Both risk scores were good predictors of in-hospital mortality in acute coronary syndrome patients and had similar areas under the receiver-operating characteristic curve (area under the curve: 0.742 for the CardShock vs 0.752 for IABP-SHOCK II, p=0.65). Their discrimination performance was only modest when applied to non-acute coronary syndrome patients (0.648 vs 0.619, respectively, p=0.31). Calibration was acceptable for both scores (Hosmer-Lemeshow p=0.22 for the CardShock and 0.68 for IABP-SHOCK II).
Conclusions:
In our cohort, both the CardShock and the IABP-SHOCK II risk scores were good predictors of in-hospital mortality in acute coronary syndrome-related cardiogenic shock.
Filiaciones:
Rivas-Lasarte, M:
CIBERCV, Cardiol Dept, Intens Cardiac Care Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
Sans-Rosello, J:
CIBERCV, Cardiol Dept, Intens Cardiac Care Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
Collado-Lledo, E:
Univ Bellvitge Hosp IDIBELL, Cardiol Serv, Barcelona, Spain
Garcia-Fernandez, V:
CIBER CV Vall dHebron Hosp, Cardiovasc Crit Care Unit, Barcelona, Spain
Noriega, FJ:
Hosp Clin San Carlos, Acute Cardiac Care Unit, Madrid, Spain
Hernandez-Perez, FJ:
Hosp Univ Puerta Hierro, Adv Heart Failure & Transplant Unit, Madrid, Spain
Fernandez-Martinez, J:
CIBERCV, Cardiol Dept, Intens Cardiac Care Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
Ariza, A:
Univ Bellvitge Hosp IDIBELL, Cardiol Serv, Barcelona, Spain
Lidon, RM:
CIBER CV Vall dHebron Hosp, Cardiovasc Crit Care Unit, Barcelona, Spain
Viana-Tejedor, A:
Hosp Clin San Carlos, Acute Cardiac Care Unit, Madrid, Spain
Segovia-Cubero, J:
Hosp Univ Puerta Hierro, Adv Heart Failure & Transplant Unit, Madrid, Spain
Harjola, VP:
Helsinki Univ Hosp, Emergency Med, Helsinki, Finland
Lassus, J:
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Thiele, H:
Univ Leipzig, Dept Internal Med Cardiol, Heart Ctr Leipzig, Leipzig, Germany
Sionis, A:
CIBERCV, Cardiol Dept, Intens Cardiac Care Unit, Hosp Santa Creu & St Pau, Barcelona, Spain
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