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Determination of a predictive score of cardiogenic shock in acute coronary syndrome
Session:
Posters 2 - Écran 9 - Doença Coronária
Speaker:
Raquel Menezes Fernandes
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Raquel Menezes Fernandes; Teresa Faria Da Mota; João De Sousa Bispo; Pedro Oliveira De Azevedo; João Pedro Moura Guedes; Daniela Carvalho; Dina Bento; Nuno Marques; Walter Santos; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction:</strong> Cardiogenic shock is one of the leading causes of death in patients with Acute coronary syndrome (ACS), reaching in-hospital mortality rates of 50%. This study pretends to identify a predictive score of cardiogenic shock in patients with ACS.</p> <p><strong>Methods:</strong> We performed a retrospective, descriptive and correlational study encompassing patients admitted with ACS in a Cardiology service from 1<sup>st</sup> October 2010 to 1<sup>st</sup> October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of cardiogenic shock were identified through a binary logistic regression analysis, considering p=0,05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analized groups. Statistical analysis was conducted with SPSS 24.0.</p> <p><strong>Results:</strong> During this period, 4458 patients were admitted with ACS and 74 (1,7%) developed cardiogenic shock. In this subgroup, 59,5% were over 65 years of age, 63,5% were male, 93,2% presented with acute myocardial infarction with ST segment elevation, 83,8% were in sinus rhythm at admission, 22,7% had creatinine>1,5 mg/dL and 17,9% had left ventricular ejection fraction (LVEF) <30%. The in-hospital mortality rate was 51,4%. LVEF <30% (p=0,018), creatinine>1,5 mg/dL (p=0,044) and absence of sinus rhythm at admission (p=0,041) were independent predictors of cardiogenic shock. A predictive score of this complication in patients with ACS was determined using the formula: 1,723 + 1,505 x (creatinine>1,5) + 4,483 x (LVEF <30%) – 2,094 x (sinus rhythm at admission). A cutoff of 0,58 was obtained with 44,4% sensitivity, 85,2% specificity and 85% discriminative power.</p> <p><strong>Conclusion:</strong> Cardiogenic shock occurred in 1,7% of patients admitted with ACS and was associated with a high mortality rate. We determined a predictive score of this complication with a good discriminative power, which included LVEF <30%, creatinine >1,5 mg/dL and the rhythm on admission’s electrocardiogram. By taking into account clinical variables, this score can be used at a very early stage of admission, allowing risk stratification of developing cardiogenic shock in each patient. It still needs validation to be applied in clinical practice.</p>
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