COMPARISON OF THE PREDICTIVE PERFORMANCE OF CARDIOGENIC SHOCK SCORES IN A REAL-WORLD LATIN AMERICA COUNTRY.

Background

Mortality in cardiogenic shock (CS) is up to 40%, and although risk scores have been proposed to stratify and assess mortality in CS, they have been shown to have inconsistent performance. The purpose was to compare CS prognostic scores and describe their performance in a real-world Latin American country.

Methods

We included 872 patients with CS. The Society for Cardiovascular Angiography and Interventions (SCAI), CARDSHOCK, IABP-Shock II, Cardiogenic Shock Score, age-lactate-creatinine score, Get-With-The-Guidelines Heart Failure score, and Acute Decompensated Heart Failure National Registry scores were calculated. Decision curve analyses were performed to evaluate the net benefit of the different scoring systems. Logistic and Cox regression analyses were applied to construct area under the curve (AUC) statistics, this last one against time using the Inverse Probability of Censoring Weighting method, for in-hospital mortality prediction.

Results

When logistic regression was applied, the scores had a moderate-good performance in the overall cohort that was higher AUC in the CARDSHOCK ( c = 0.666). In acute myocardial infarction-related CS (AMI-CS), CARDSHOCK still is the highest AUC (0.68). In non-AMI-CS only SCAI (0.668), CARDSHOCK (0.533), and IABP-SHOCK II (0.636) had statistically significant values. When analyzed over time, significant differences arose in the AUC, suggesting that a time-sensitive component influenced the prediction of mortality. The highest AUC was for the CARDSHOCK score (0.658), followed by SCAI (0.622). In AMI-CS-related, the highest AUC was for the CARDSHOCK score (0.671). In non-AMI-CS, SCAI was the best (0.642).

Conclusions

Clinical scores show a time-sensitive AUC, suggesting that performance could be influenced by time and the type of CS. Understanding the temporal influence on the scores could provide a better prediction and be a valuable tool in CS.