Aims Several prediction models have been developed to allow accurate risk assessment and provide better treatment guidance in patients with infarct-related cardiogenic shock (CS). However, comparative data between these models are still scarce. The objective of the study is to externally validate different risk prediction models in infarct-related CS and compare their predictive value in the early clinical course. Methods and results The Simplified Acute Physiology Score (SAPS) II Score, the CardShock score, the IABP-SHOCK II score, and the Society for Cardiovascular Angiography and Intervention (SCAI) classification were each externally validated in a total of 1055 patients with infarct-related CS enrolled into the randomized CULPRIT-SHOCK trial or the corresponding registry. The primary outcome was 30-day all-cause mortality. Discriminative power was assessed by comparing the area under the curves (AUC) in case of continuous scores. In direct comparison of the continuous scores in a total of 161 patients, the IABP-SHOCK II score revealed best discrimination [area under the curve (AUC = 0.74)], followed by the CardShock score (AUC = 0.69) and the SAPS II score, giving only moderate discrimination (AUC = 0.63). All of the three scores revealed acceptable calibration by Hosmer–Lemeshow test. The SCAI classification as a categorical predictive model displayed good prognostic assessment for the highest risk group (Stage E) but showed poor discrimination between Stages C and D with respect to short-term-mortality. Conclusion Based on the present findings, the IABP-SHOCK II score appears to be the most suitable of the examined models for immediate risk prediction in infarct-related CS. Prospective evaluation of the models, further modification, or even development of new scores might be necessary to reach higher levels of discrimination.

中文翻译：

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梗死相关心源性休克风险预测模型的比较

目的 已经开发了几种预测模型，以便对梗死相关心源性休克 (CS) 患者进行准确的风险评估并提供更好的治疗指导。然而，这些模型之间的比较数据仍然很少。该研究的目的是从外部验证梗死相关 CS 中的不同风险预测模型，并比较它们在早期临床过程中的预测价值。方法和结果 简化急性生理学评分 (SAPS) II 评分、CardShock 评分、IABP-SHOCK II 评分和心血管血管造影和干预协会 (SCAI) 分类分别在总共 1055 例梗死患者中进行了外部验证。相关 CS 参加了随机 CULPRIT-SHOCK 试验或相应的注册。主要结果是 30 天全因死亡率。在连续得分的情况下，通过比较曲线下面积 (AUC) 来评估辨别力。在对总共 161 名患者的连续评分的直接比较中，IABP-SHOCK II 评分显示出最好的辨别力 [曲线下面积 (AUC = 0.74)]，其次是 CardShock 评分 (AUC = 0.69) 和 SAPS II 评分，只给出中度歧视（AUC = 0.63）。通过 Hosmer-Lemeshow 测试，所有三个分数均显示可接受的校准。SCAI 分类作为分类预测模型对最高风险组（E 期）显示出良好的预后评估，但在短期死亡率方面 C 期和 D 期之间的区分度较差。结论 根据目前的调查结果，IABP-SHOCK II 评分似乎是最适合用于梗死相关 CS 的即时风险预测的检查模型。可能需要对模型进行前瞻性评估、进一步修改甚至开发新分数，以达到更高水平的歧视。