Aims To derive and validate a readily useable risk score to identify patients at high-risk of in-hospital ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS). Methods and results In all, 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire Régional Breton sur l'Infarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Côte-d'Or (RICO) constituted the external validation cohort. Stepwise multivariable logistic regression was used to build the score. Eleven variables were independently associated with the development of in-hospital CS: age >70 years, prior stroke/transient ischaemic attack, cardiac arrest upon admission, anterior STEMI, first medical contact-to-pPCI delay >90 min, Killip class, heart rate >90/min, a combination of systolic blood pressure <125 mmHg and pulse pressure <45 mmHg, glycaemia >10 mmol/L, culprit lesion of the left main coronary artery, and post-pPCI thrombolysis in myocardial infarction flow grade <3. The score derived from these variables allowed the classification of patients into four risk categories: low (0-7), low-to-intermediate (8-10), intermediate-to-high (11-12), and high (≥13). Observed in-hospital CS rates were 1.3%, 6.6%, 11.7%, and 31.8%, across the four risk categories, respectively. Validation in the RICO cohort demonstrated in-hospital CS rates of 3.1% (score 0-7), 10.6% (score 8-10), 18.1% (score 11-12), and 34.1% (score ≥13). The score demonstrated high discrimination (c-statistic of 0.84 in the derivation cohort, 0.80 in the validation cohort) and adequate calibration in both cohorts. Conclusion The ORBI risk score provides a readily useable and efficient tool to identify patients at high-risk of developing CS during hospitalization following STEMI, which may aid in further risk-stratification and thus potentially facilitate pre-emptive clinical decision making.

中文翻译：

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预测经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者院内心源性休克的发展：ORBI 风险评分

目的 推导出和验证易于使用的风险评分，以识别出院内 ST 段抬高型心肌梗死 (STEMI) 相关心源性休克 (CS) 高危患者。方法和结果 总共有 6838 名入院时未发生 CS 并接受直接经皮冠状动脉介入治疗 (pPCI) 的患者，包括在 Observatoire Régional Breton sur l'Infarctus (ORBI) 中，作为衍生队列，2208 名患者包括在观察中des Infarctus de Côte-d'Or (RICO) 构成外部验证队列。逐步多变量逻辑回归用于建立分数。11 个变量与院内 CS 的发生独立相关：年龄 >70 岁、既往卒中/短暂性脑缺血发作、入院时心脏骤停、前壁 STEMI、首次医疗接触 pPCI 延迟 > 90 分钟，Killip 级，心率 >90/分钟，收缩压 <125 mmHg 和脉压 <45 mmHg 的组合，血糖 >10 mmol/L，左冠状动脉主干的罪犯病变，以及 pPCI 后溶栓心肌梗塞血流等级<3。从这些变量得出的分数允许将患者分为四个风险类别：低 (0-7)、低到中 (8-10)、中到高 (11-12) 和高 (≥13 ）。在四个风险类别中，观察到的住院 CS 率分别为 1.3%、6.6%、11.7% 和 31.8%。RICO 队列中的验证表明，院内 CS 率为 3.1%（得分 0-7）、10.6%（得分 8-10）、18.1%（得分 11-12）和 34.1%（得分≥13）。该分数显示出高区分度（推导队列中的 c 统计量为 0.84，0. 80 在验证队列中）和两个队列中的充分校准。结论 ORBI 风险评分提供了一种易于使用且有效的工具，可用于识别 STEMI 后住院期间发生 CS 的高风险患者，这可能有助于进一步的风险分层，从而有可能促进先发制人的临床决策。