Abstract
Type of funding sources: None.
Shock is the main cause of in-hospital mortality in the setting of the Acute Coronary Syndromes (ACS). Shock Index (SI) Has been propposed as an useful predictor of shock and prognosis of the patients admitted because of an ACS. Not only this, a new index, derived from the previous one, which is known as Age Shock Index (ASI) seems to be even more accurate when evaluating these patients.
Our first aim is to test if ASI is more accurate than SI to predict the occurrence of shock in patients admitted to the hospital with the diagnosis of ACS. Our second aim is to check if ASI is more accurate than SI, GRACE score and CRUSADE score to predict the in-hospital mortality of patients admitted to a hospital with the diagnosis of ACS and the presence of shock in the moment of the admission.
Observational, retrospective and single-center study including patients admitted to a Coronary Critical Care Unit (CCCU) between July 2.011 and March 2.021. ASI was calculated with the following formula: (heart rate x age) / systolic blood pressure.
We calculated receptor-operative curves (ROC) of ASI and SI as predictors of shock for patients not presenting shock at the admision. We also calculated ROC of ASI, SI, GRACE and CRUSADE as predictors of in-hospital mortality of patients admitted in shock situation. We compared the area under the curve (AUC) between them.
For the shock-prediction test we included 2.537 patients, who were admitted in Killip score <4. We found that ASI was a better predictor than SI, with a bigger AUC (0,76 (0,73–079) vs 0,72 (0,68–0,76), p<0,001, Picture 1) , being 44,6 the optimal cut point with better sensibility (0,67) and specificity (0,76).
For the in-hospital mortality in shock patients prediction test we included 240 patients admitted in Killip score = 4. As we show in Picture 2, ASI was found to be a better predictor than SI and GRACE score, but not better than CRUSADE score, being 49,2 the optimal cut point with better sensibility (0,71) and specificity (0,53)
ASI is a better predictor of shock in patients admitted because of ACS than SI and also a better predictor of in-hospital mortality than SI and GRACE score in patients admitted because of ACS and a situation of shock at the admision. Althoug it was not better that CRUSADE score for this purpose, in favour of this index we highlight its simplicity of calculation, which, together with his good prediction capability, make it very useful in the acute setting.
Shock test
Mortality test
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