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External validation and comparison of the CardShock and IABPII shock risk scores in real-life cardiogenic shock patients

Session Moderated Poster Session - Acute heart failure

Speaker Javier Segovia Cubero

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Moderated Posters

Authors : M Rivas Lasarte (Barcelona,ES), J Sans-Rosello (Barcelona,ES), E Collado Lledo (Barcelona,ES), V Gonzalez Fernandez (Barcelona,ES), J Fernandez Martinez (Barcelona,ES), F Noriega Sanz (Madrid,ES), F Hernandez Perez (Madrid,ES), J Segovia (Madrid,ES), A Viana (Madrid,ES), RM Lidon (Barcelona,ES), A Ariza (Barcelona,ES), A Sionis (Barcelona,ES)

Authors:
M Rivas Lasarte1 , J Sans-Rosello1 , E Collado Lledo2 , V Gonzalez Fernandez3 , J Fernandez Martinez1 , F Noriega Sanz4 , F Hernandez Perez5 , J Segovia5 , A Viana4 , RM Lidon3 , A Ariza2 , A Sionis1 , 1Hospital de la Santa Creu i Sant Pau, Cardiology Department - Barcelona - Spain , 2University Hospital of Bellvitge, Cardiology - Barcelona - Spain , 3University Hospital Vall d'Hebron, Cardiology - Barcelona - Spain , 4Hospital Clínico San Carlos, Cardiology - Madrid - Spain , 5University Hospital Puerta de Hierro Majadahonda, Cardiology - Madrid - Spain ,

Citation:

Background: The recently published CardShock and the IABPII-Shock scores have shown a good performance in predicting short-term mortality. To date, they have not been compared in a large cohort of real-life patients.

Methods: This is a multicenter retrospective cohort study of CS patients. 

Results: The 696 patients with complete data were analyzed. Acute Coronary Syndrome (ACS) was the main cause of shock in 62% of patients. The main characteristics of patients are summarized in the table. The Cardshock risk score and the IABPII risk score were good in-hospital mortality predictors with similar Areas Under the ROC Curve in ACS patients (AUC: 0.742 vs 0.752, p=0.551). The discrimination performance dropped when the scores were applied to non-ACS patients (0.648 vs 0.619, respectively p=0.310). Calibration was acceptable for both scores (non-significant Hosmer-Lemeshow test).

Conclusions: The Cardshock and the IABPII shock risk scores were good predictors of in-hospital mortality. The lower ability of both scores to predict the short-term prognosis in non-ACS patients may be related to their marked heterogeneity.

ACS

434 patients

62%

Non-ACS

262 patients

38%

p-value
Age (years), mean (SD) 68 (13) 61 (16) <0.0001
Hypertension 281 (65%) 133 (51%) <0.001
Diabetes 183 (42%) 100 (38%) 0.298
Smokers 159 (37%) 71 (27%) 0.028
Renal insufficiency 61 (14%) 61 (23%) 0.002
Previous myocardial infarction 77 (18%) 63 (24%) 0.044
Previous heart failure 46 (10%) 151 (58%) <0.001
Cardiac arrest 119 (27%) 25 (13%) <0.001
CardShock risk score, mean (SD) 5 (2) 4 (2) <0.0001
IABPIIshock risk score, mean (SD) 2.8(1.8) 2.0 (1.6) <0.0001
Dobutamine 392 (90%) 237 (90%) 0.953
Invasive mechanical ventilation 275 (63%) 156 (60%) 0.314
Renal replacement therapy 80 (18%) 53 (20%) 0.543
IABP 245 (56%) 82 (31%) <0.001
LVAD or BiVAD (Levitronix) 14 (3%) 28 (11%) <0.001
In-hospital mortality 198 (45%) 112 (43%) 0.460

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