Aims Shock index (SI), defined as the ratio of heart rate (HR) to systolic blood pressure (SBP), is easily obtained and predictive of mortality in patients with ST-segment elevation myocardial infarction. However, large-scale evaluations of SI in patients with non-ST-segment elevation myocardial infarction (NSTEMI) are lacking. Methods and results Hospitalizations for acute myocardial infarction were sampled from four US areas by the Atherosclerosis Risk in Communities (ARIC) study and classified by physician review. Shock index was derived from the HR and SBP at first presentation and considered high when ≥0.7. From 2000 to 2014, 18 301 weighted hospitalizations for NSTEMI were sampled and had vitals successfully obtained. Of these, 5753 (31%) had high SI (≥0.7). Patients with high SI were more often female (46% vs. 39%) and had more prevalent chronic kidney disease (40% vs. 32%). TIMI (Thrombolysis in Myocardial Infarction) risk scores were similar between the groups (4.3 vs. 4.2), but GRACE (Global Registry of Acute Coronary Syndrome) score was higher with high SI (140 vs. 118). Angiography, revascularization, and guideline-directed medications were less often administered to patients with high SI, and the 28-day mortality was higher (13% vs. 5%). Prediction of 28-day mortality by SI as a continuous measurement [area under the curve (AUC): 0.68] was intermediate to that of the GRACE score (AUC: 0.87) and the TIMI score (AUC: 0.54). After adjustments, patients with high SI had twice the odds of 28-day mortality (odds ratio = 2.02; 95% confidence interval: 1.46–2.80). Conclusion The SI is easily obtainable, performs moderately well as a predictor of short-term mortality in patients hospitalized with NSTEMI, and may be useful for risk stratification in emergency settings.

中文翻译：

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休克指数对非 ST 段抬高型心肌梗死患者的预后价值：ARIC 研究社区监测

目标 休克指数 (SI) 定义为心率 (HR) 与收缩压 (SBP) 的比值，很容易获得，可以预测 ST 段抬高型心肌梗死患者的死亡率。然而，缺乏对非 ST 段抬高型心肌梗死 (NSTEMI) 患者 SI 的大规模评估。方法和结果 通过社区动脉粥样硬化风险 (ARIC) 研究对美国四个地区因急性心肌梗死住院的患者进行了抽样，并根据医生审查进行分类。休克指数源自初次就诊时的 HR 和 SBP，当≥0.7 时被视为高。从2000年到2014年，对18 301例NSTEMI住院患者进行了采样，并成功获得了生命体征。其中，5753 名（31%）的 SI 较高（≥0.7）。SI 高的患者多为女性（46% vs. 39%），并且患有更常见的慢性肾病（40% vs. 32%）。两组之间的 TIMI（心肌梗塞溶栓）风险评分相似（4.3 比 4.2），但 GRACE（急性冠脉综合征全球登记）评分较高且 SI 较高（140 比 118）。高 SI 患者较少接受血管造影、血运重建和指南指导药物治疗，且 28 天死亡率较高（13% 与 5%）。SI 作为连续测量的 28 天死亡率预测 [曲线下面积 (AUC)：0.68] 介于 GRACE 评分 (AUC：0.87) 和 TIMI 评分 (AUC：0.54) 之间。调整后，SI 高的患者 28 天死亡率的几率是原来的两倍（优势比 = 2.02；95% 置信区间：1.46–2.80）。结论 SI 很容易获得，作为 NSTEMI 住院患者短期死亡率的预测指标表现较好，并且可能有助于紧急情况下的风险分层。