International journal of cardiology. Heart & vasculature · 2026
Mortality risk stratification in contemporary myocardial infarction-related cardiogenic shock: development of AMICS-ADMIT prediction model and benchmarking of established scores.
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Mihali Klevis, Markus Birgit, Neuner Kornelia, Chatzis Georgios, Harbaum Lukas, Fomin Mykyta, Choukeir Maryana, Syntila Styliani, Schieffer Bernhard, Kreutz Julian
Аннотация
BACKGROUND: Mortality risk stratification in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains challenging with heterogeneous temporary mechanical circulatory support (tMCS) use. We developed and temporally validated the admission-based AMICS-ADMIT model and bedside score and benchmarked them against established scores.
METHODS: This retrospective single-centre study, reported according to TRIPOD+AI, included 479 consecutive patients with AMI-CS undergoing percutaneous coronary intervention (PCI) between January 2017 and July 2025. The primary endpoint was in-hospital mortality. AMICS-ADMIT was developed using multivariable logistic regression in the 2017-2022 cohort, internally evaluated by bootstrap resampling, and temporally validated in the 2023-2025 cohort. Missing data were multiply imputed. Performance was assessed using discrimination, calibration, and Brier scores. Benchmarking against CardShock, IABP-SHOCK II, and GRACE was restricted to temporal validation; tMCS-stratified performance was exploratory.
RESULTS: In-hospital mortality was 42.6% (204/479). The final model included age, left ventricular ejection fraction, prior cardiopulmonary resuscitation, estimated glomerular filtration rate, vasoactive-inotropic score, and ST-segment elevation status. The continuous model achieved AUCs of 0.809 (95% CI 0.764-0.855) in development and 0.834 (95% CI 0.769-0.899) in temporal validation, with Brier scores of 0.176 and 0.167 and favourable calibration. The bedside score achieved AUCs of 0.777 (95% CI 0.728-0.826) and 0.775 (95% CI 0.699-0.851), respectively, with stepwise mortality separation across predefined risk categories. Discrimination did not differ significantly from CardShock, IABP-SHOCK II, or GRACE.
CONCLUSIONS: AMICS-ADMIT showed stable temporal performance and clinically interpretable early risk stratification in contemporary PCI-treated AMI-CS. External multicentre validation is required before clinical implementation.
METHODS: This retrospective single-centre study, reported according to TRIPOD+AI, included 479 consecutive patients with AMI-CS undergoing percutaneous coronary intervention (PCI) between January 2017 and July 2025. The primary endpoint was in-hospital mortality. AMICS-ADMIT was developed using multivariable logistic regression in the 2017-2022 cohort, internally evaluated by bootstrap resampling, and temporally validated in the 2023-2025 cohort. Missing data were multiply imputed. Performance was assessed using discrimination, calibration, and Brier scores. Benchmarking against CardShock, IABP-SHOCK II, and GRACE was restricted to temporal validation; tMCS-stratified performance was exploratory.
RESULTS: In-hospital mortality was 42.6% (204/479). The final model included age, left ventricular ejection fraction, prior cardiopulmonary resuscitation, estimated glomerular filtration rate, vasoactive-inotropic score, and ST-segment elevation status. The continuous model achieved AUCs of 0.809 (95% CI 0.764-0.855) in development and 0.834 (95% CI 0.769-0.899) in temporal validation, with Brier scores of 0.176 and 0.167 and favourable calibration. The bedside score achieved AUCs of 0.777 (95% CI 0.728-0.826) and 0.775 (95% CI 0.699-0.851), respectively, with stepwise mortality separation across predefined risk categories. Discrimination did not differ significantly from CardShock, IABP-SHOCK II, or GRACE.
CONCLUSIONS: AMICS-ADMIT showed stable temporal performance and clinically interpretable early risk stratification in contemporary PCI-treated AMI-CS. External multicentre validation is required before clinical implementation.