Prognostic performance of the IABP-SHOCK II Risk Score among cardiogenic shock subtypes in the critical care cardiology trials network registry

• Published in: The American heart journal Vol. 270; pp. 1 - 12
• Main Authors: Alviar, Carlos L., Li, Boyangzi K., Keller, Norma M., Bohula-May, Erin, Barnett, Christopher, Berg, David D., Burke, James A., Chaudhry, Sunit-Preet, Daniels, Lori B., DeFilippis, Andrew P., Gerber, Daniel, Horowitz, James, Jentzer, Jacob C., Katrapati, Praneeth, Keeley, Ellen, Lawler, Patrick R., Park, Jeong-Gun, Sinha, Shashank S., Snell, Jeffrey, Solomon, Michael A., Teuteberg, Jeffrey, Katz, Jason N., van Diepen, Sean, Morrow, David A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2024; Elsevier Limited
• Subjects: Aged; Cardiology; Cardiomyopathy; Clinical trials; Creatinine; Critical Care; Decision making; Etiology; Heart; Hemodynamics; Hospitals; Humans; Intensive care; Intensive care units; Intra-Aortic Balloon Pumping - adverse effects; Medical prognosis; Mortality; Myocardial infarction; Patients; Percutaneous Coronary Intervention - adverse effects; Phenotypes; Prognosis; Pulmonary arteries; Registries; Risk assessment; Risk Factors; Shock; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Statistical analysis; Treatment Outcome; Variables; Ventricle
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2023.12.018

Risk stratification has potential to guide triage and decision-making in cardiogenic shock (CS). We assessed the prognostic performance of the IABP-SHOCK II score, derived in Europe for acute myocardial infarct-related CS (AMI-CS), in a contemporary North American cohort, including different CS phenotypes. The critical care cardiology trials network (CCCTN) coordinated by the TIMI study group is a multicenter network of cardiac intensive care units (CICU). Participating centers annually contribute ≥2 months of consecutive medical CICU admissions. The IABP-SHOCK II risk score includes age > 73 years, prior stroke, admission glucose > 191 mg/dl, creatinine > 1.5 mg/dl, lactate > 5 mmol/l, and post-PCI TIMI flow grade < 3. We assessed the risk score across various CS etiologies. Of 17,852 medical CICU admissions 5,340 patients across 35 sites were admitted with CS. In patients with AMI-CS (n = 912), the IABP-SHOCK II score predicted a >3-fold gradient in in-hospital mortality (low risk = 26.5%, intermediate risk = 52.2%, high risk = 77.5%, P < .0001; c-statistic = 0.67; Hosmer-Lemeshow P = .79). The score showed a similar gradient of in-hospital mortality in patients with non-AMI-related CS (n = 2,517, P < .0001) and mixed shock (n = 923, P < .001), as well as in left ventricular (<0.0001), right ventricular (P = .0163) or biventricular (<0.0001) CS. The correlation between the IABP-SHOCK II score and SOFA was moderate (r2 = 0.17) and the IABP-SHOCK II score revealed a significant risk gradient within each SCAI stage. In an unselected international multicenter registry of patients admitted with CS, the IABP- SHOCK II score only moderately predicted in-hospital mortality in a broad population of CS regardless of etiology or irrespective of right, left, or bi-ventricular involvement.