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Utility of the Age Shock Index in patients with an acute coronary syndrome
Session:
Posters (Sessão 2 - Écran 6) - DAC e Cuidados Intensivos 3 - SCAsST
Speaker:
Pedro Rocha Carvalho
Congress:
CPC 2022
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:
Pósters Electrónicos
FP Number:
---
Authors:
Pedro Rocha Carvalho; Jose Monteiro; Catarina Carvalho; Marta Bernardo; Paulo Fontes; Ilidio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Introduction:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> The Shock Index (SI), </span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">defined as the ratio of heart rate (HR) to systolic blood pressure (SBP),</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">represents a bedside reflection of the integrated response from the cardiovascular and autonomic systems. It is determined by the heart rate and systolic blood pressure ratio and has been reported to help us predict adverse prognosis in patients with acute coronary syndromes (ACS). However, the prognostic value of the Age Shock Index (ASI), product of the SI multiplied with age, is yet to be determined in ACS patients.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> <span style="background-color:white"><span style="color:#212529">Retrospective study of patients with ACS periodically included in our center registry between October/2012 and </span></span>September/2018. Patients were categorized into two groups based on their initial ASI. Optimal shock index cutoff was determined according to ROC curve analysis. Baseline characteristics, management and outcomes were compared between the two groups. The primary outcome <span style="background-color:white">was cardiovascular death.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> A total of 578 patients were selected, with a mean age of 66,9±13,1 years, 75,2% were male, 42,6% had a ST-elevation myocardial infarction. Based on ROC analysis the optimal ASI cutoff was 42 and, therefore, 69,6% had an ASI <42 and 30,4% had an ASI ≥42. The former group was older (mean age of 74,4±10,0 vs 62,5±12,5 years, p<0,001), had more comorbidities: arterial hypertension (75,6% vs 58,0%, p=0,001), diabetes <em>mellitus</em> (36,4% vs 27,9%, p=0,04), peripheral artery disease (2,2% vs 6,3%, p=0,02), had higher Killip class at admission and worse left ventricular ejection fraction on discharge (45,5±12,2 vs 51,3±10,6, p<0,001).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">During a median follow-up of 42 months (IQR: 27-59), 52 patients (9%) died from cardiovascular causes. In a multivariate regression analysis, after adjusting for all the possible confounders, ASI≥42 was an independent predictor of cardiovascular death (HR 4,35, 95% CI: 1,87-10,09, p<0,001).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> ASI can identify patients at high risk of cardiovascular death in ACS patients and, combined with its simple use, makes it a practical tool for early risk stratification in these patients.</span></span></span></span></p>
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