INTRODUCTION: Prompt identification of higher-risk patients presenting with ST-segment elevation myocardial infarction (STEMI) is crucial to pursue a more aggressive approach. OBJECTIVE: We aimed to assess whether the modified shock index (MSI), the ratio of heart rate to mean arterial pressure, could predict six-month mortality among patients admitted with STEMI. METHODS: A retrospective observational cohort study was performed in a single center including 1158 patients diagnosed with STEMI, without cardiogenic shock on admission, between July 2009 and December 2014. They were divided into two groups: group 1 - patients with MSI<0.93 (72%); group 2 - patients with MSI≥0.93 (28%). The primary endpoint was six-month all-cause mortality. RESULTS: MSI≥0.93 identified patients who were more likely to have signs of heart failure (p=0.002), anemia (p<0.001), renal insufficiency (p=0.014) and left ventricular systolic dysfunction (p=0.045). They more often required inotropic support (p<0.001), intra-aortic balloon pump (p<0.001) and mechanical ventilation (p<0.001). Regarding in-hospital adverse events, they had a higher prevalence of malignant arrhythmias (p=0.01) and mechanical complications (p=0.027). MSI≥0.93 was an independent predictor of overall six-month mortality (adjusted HR 2.00, 95% CI 1.20-3.34, p=0.008). CONCLUSION: MSI was shown to be a valuable bedside tool which can rapidly identify high-risk STEMI patients at presentation.
INTRODUCTION: Prompt identification of higher-risk patients presenting with ST-segment elevation myocardial infarction (STEMI) is crucial to pursue a more aggressive approach. OBJECTIVE: We aimed to assess whether the modified shock index (MSI), the ratio of heart rate to mean arterial pressure, could predict six-month mortality among patients admitted with STEMI. METHODS: A retrospective observational cohort study was performed in a single center including 1158 patients diagnosed with STEMI, without cardiogenic shock on admission, between July 2009 and December 2014. They were divided into two groups: group 1 - patients with MSI<0.93 (72%); group 2 - patients with MSI≥0.93 (28%). The primary endpoint was six-month all-cause mortality. RESULTS: MSI≥0.93 identified patients who were more likely to have signs of heart failure (p=0.002), anemia (p<0.001), renal insufficiency (p=0.014) and left ventricular systolic dysfunction (p=0.045). They more often required inotropic support (p<0.001), intra-aortic balloon pump (p<0.001) and mechanical ventilation (p<0.001). Regarding in-hospital adverse events, they had a higher prevalence of malignant arrhythmias (p=0.01) and mechanical complications (p=0.027). MSI≥0.93 was an independent predictor of overall six-month mortality (adjusted HR 2.00, 95% CI 1.20-3.34, p=0.008). CONCLUSION: MSI was shown to be a valuable bedside tool which can rapidly identify high-risk STEMI patients at presentation.
Authors: Timo Schmitz; Eva Harmel; Jakob Linseisen; Inge Kirchberger; Margit Heier; Annette Peters; Christa Meisinger Journal: Ann Med Date: 2022-12 Impact factor: 4.709
Authors: Lorena Millo; Alexander McKenzie; Andrew De la Paz; Cynthia Zhou; Michael Yeung; George A Stouffer Journal: Am J Cardiol Date: 2021-07-12 Impact factor: 3.133