Evaluation of the success of shock index and its derivatives in determining mortality in STEMI cases applied to emergency department

Abstract

Objectives: The shock index (SI) and its derivatives play a crucial role in rapid prognosis and risk assessment, particularly in emergent scenarios like ST-segment elevation myocardial infarction (STEMI).

Methods: This study was conducted as a single-centered retrospective. A total of 467 cases that met the study criteria with a confirmed STEMI diagnosis were included. The SI, modified SI (MSI), age SI (ASI), and age-modified SI (AMSI) scores of the cases were calculated and compared. In this study, p 0.05 was accepted as the statistical significance level.

Results: Calculated scores were compared among cases meeting STEMI criteria. Mortal cases displayed significantly higher SI, MSI, ASI, and AMSI, as well as elevated heart rates and lowered SBP, DBP, and MAP values. ASI exhibited the highest predictive success for mortality (AUC: 0.802), followed by AMSI (AUC: 0.798). AMSI demonstrated superior significance in estimating major adverse cardiovascular events (MACE) (p < 0.001 for each parameter).

Conclusions: ASI proved most effective in gauging mortality risk, while AMSI excelled in predicting MACE risk among SI derivatives. These indices hold promise for guiding patient triage and emergency care in STEMI cases, owing to their simplicity and predictive capacity.

Keywords

• Emergency department
• mortality
• shock index
• modified shock index
• STEMI

References

1. 1. Allgöwer M, Burri C. ["Shock index"]. Dtsch Med Wochenschr 1967;92:1947-50. [Article in German]
2. 2. Çakır E, Bindal A, Yilmaz P, Mutlu N, Doğu C, Turan I. [Utility of shock indexes in predicting early results of septic shock patients in intensive care unit]. Acıbadem Univ Sağlık Bilim Derg 2021;12:234-9. [Article in Turkish]
3. 3. Koch E, Lovett S, Nghiem T, Riggs RA, Rech MA. Shock index in the emergency department: utility and limitations. Open Access Emerg Med 2019;11:179-99.
4. 4. Zhang X, Wang Z, Wang Z, Fang M, Shu Z. The prognostic value of shock index for the outcomes of acute myocardial infarction patients: a systematic review and meta-analysis. Medicine (Baltimore) 2017;96:e8014.
5. 5. Reinstadler SJ, Fuernau G, Eitel C, de Waha S, Desch S, Metzler B, et al. Shock index as a predictor of myocardial damage and clinical outcome in ST-elevation myocardial infarction. Circ J 2016;80:924-30.
6. 6. Yu T, Tian C, Song J, He D, Sun Z, Sun Z. Age shock index is superior to shock index and modified shock index for predicting long-term prognosis in acute myocardial infarction. Shock 2017;48:545-50.
7. 7. Chunawala ZS, Hall ME, Arora S, Dai X, Menon V, Smith SC, et al. Prognostic value of shock index in patients admitted with non-ST-segment elevation myocardial infarction: the ARIC study community surveillance. Eur Heart J Acute Cardiovasc Care 2021;10:869-77.
8. 8. Abe N, Miura T, Miyashita Y, Hashizume N, Ebisawa S, Motoki H, et al. Long-term prognostic implications of the admission shock index in patients with acute myocardial infarction who received percutaneous coronary intervention. Angiology 2017;68:339-45.

9. 9. Abreu G, Azevedo P, Galvão Braga C, Vieira C, Álvares Pereira M, Martins J, et al. Modified shock index: a bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation. Rev Port Cardiol (Engl Ed) 2018;37:481-8.
10. 10. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119-77.
11. 11. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2016;67:1235-50.
12. 12. Al Aseri Z, Al Ageel M, Binkharfi M. The use of the shock index to predict hemodynamic collapse in hypotensive sepsis patients: A cross-sectional analysis. Saudi J Anaesth. 2020;14:192-9.
13. 13. Bilkova D, Motovska Z, Widimsky P, Dvorak J, Lisa L, Budesinsky T. Shock index: a simple clinical parameter for quick mortality risk assessment in acute myocardial infarction. Can J Cardiol 2011;27:739-42.
14. 14. Hemradj VV, Ottervanger JP, de Boer MJ, Suryapranata H; Zwolle Myocardial Infarction Study Group. Shock index more sensitive than cardiogenic shock in ST-elevation myocardial infarction treated by primary percutaneous coronary intervention. Circ J 2017;81:199-205.
15. 15. Zhou J, Shan PR, Xie QL, Zhou XD, Cai MX, Xu TC, et al. Age shock index and age-modified shock index are strong predictors of outcomes in ST-segment elevation myocardial infarction patients undergoing emergency percutaneous coronary intervention. Coron Artery Dis 2019;30:398-405.
16. 16. Kobayashi A, Misumida N, Luger D, Kanei Y. Shock Index as a predictor for In-hospital mortality in patients with non-ST-segment elevation myocardial infarction. Cardiovasc Revasc Med 2016;17:225-8.
17. 17. Schmitz T, Harmel E, Linseisen J, Kirchberger I, Heier M, Peters A, et al. Shock index and modified shock index are predictors of long-term mortality not only in STEMI but also in NSTEMI patients. Ann Med 2022;54:900-8.
18. 18. Chiang CY, Lin CF, Liu PH, Chen FC, Chiu IM, Cheng FJ. Clinical validation of the shock index, modified shock index, delta shock index, and shock index-C for emergency department ST-segment elevation myocardial infarction. J Clin Med 2022;11:5839.
19. 19. Shangguan Q, Xu JS, Su H, Li JX, Wang WY, Hong K, et al. Modified shock index is a predictor for 7-day outcomes in patients with STEMI. Am J Emerg Med 2015;33:1072-5.
20. 20. Soiza RL, Leslie SJ, Harrild K, Peden NR, Hargreaves AD. Age-dependent differences in presentation, risk factor profile, and outcome of suspected acute coronary syndrome. J Am Geriatr Soc 2005;53:1961-5.
21. 21. Crudeli E, Lazzeri C, Stefàno P, Chiostri M, Blanzola C, Rossi A, et al. Age as a prognostic factor in patients with acute coronary syndrome undergoing urgent/emergency cardiac surgery. Heart Lung Circ 2015;24:845-53.