Long-Term Prognostic Implications of the Admission Shock Index in Patients With Acute Myocardial Infarction Who Received Percutaneous Coronary Intervention

Abstract

The admission shock index (SI) enables prediction of short-term prognosis. This study investigated the prognostic implications of admission SI for predicting long-term prognoses for acute myocardial infarction (AMI). The participants were 680 patients with AMI who received percutaneous coronary intervention. Shock index is the ratio of heart rate and systolic blood pressure. Patients were classified as admission SI <0.66 (normal) and ≥0.66 (elevated; 75th percentile). The end point was 5-year major adverse cardiac events (MACEs). Elevated admission SI was seen in 176 patients. Peak creatine kinase levels were significantly higher and left ventricular ejection fraction was lower in the elevated SI group, which had a worse MACEs. In multivariate Cox regression analysis, SI ≥0.66 was a risk factor for MACE. Elevated admission SI was associated with poorer long-term prognosis.

The prognostic value of shock index for the outcomes of acute myocardial infarction patients

“…According to the inclusion criteria, 8 studies enrolling 20,404 patients were eventually included in the systemic review and meta-analysis. Of the 8 studies, 2 showed only in-hospital mortality, [ 6 , 13 ] 2 reported only short-term adverse outcomes, [ 7 , 9 ] 2 assessed only long-term MACE, [ 10 , 12 ] 1 evaluated both in-hospital and long-term mortality, [ 8 ] and 1 measured both short-term and long-term mortality. [ 11 ] Therefore, there were 3, 3, and 4 studies for the analyses of in-hospital mortality, short-term, and long-term adverse outcomes, respectively.…”

“…[ 7 ] Another study has demonstrated that admission SI ≥0.66 were identified as an independent predictor of major adverse cardiac events (MACEs) with a cumulative hazard ratio for 5-year MACEs of 2.14. [ 10 ] Elevated SI has also been shown as a risk factor of in-hospital mortality in patients undergoing primary percutaneous coronary intervention (PCI). [ 8 ]…”

“…Although more and more studies have revealed the prognostic value of elevated SI in the AMI patients, the quality of the studies vary widely. [ 6 , 7 , 10 , 11 , 13 ] Up to now, there has been no systematic review to evaluate the relationship between elevated SI and the in-hospital, short-term, and long-term adverse outcome, respectively. Therefore, we conducted a systematic review and meta-analysis of clinical trials to determine the effect of high SI on the prognosis of AMI patients.…”

Equivalency between the shock index and subtracting the systolic blood pressure from the heart rate: An observational cohort study

“…The collected data included HR in the emergency department (ED), SBP in the ED, age, sex, trauma, pregnancy status, acute myocardial infarction, sepsis, chronic respiratory disease (previous history of chronic obstructive pulmonary disease, chronic bronchitis, asthma, bronchiectasis, interstitial pneumonia, pulmonary tuberculosis, or lung cancer), and intracranial disease (having suffered from stroke, transient ischemic attack, encephalitis, encephalopathy, seizure, brain tumour, hydrocephalus, concussion, cerebral contusion, or traumatic subarachnoid haemorrhage at arrival to ED). These speci c patient characteristics were included since many previous studies have examined the ability of the SI to predict mortality or other critical conditions in those with trauma, pregnancy, acute myocardial infarction, sepsis, and intracranial disease [2][3][4][5][6][7][8][9][10][11][12][13][14][15], and because HR and SBP of aged or chronic respiratory disease patients are known to exhibit speci c dynamics [24][25][26].…”

“…The shock index (SI) is an indicator of the severity of hypovolemic shock and is calculated by dividing the heart rate (HR) by systolic blood pressure (SBP) [1]. It serves to predict the mortality, need for blood transfusion, or necessity of intensive care unit admission among patients with trauma [2][3][4][5][6][7], postpartum haemorrhage [8,9], acute myocardial infarction [10,11], stroke [12,13], sepsis [14,15], and other critical conditions [16,17]. Numerous previous studies have demonstrated that the SI demonstrates superior prediction for mortality to traditional vital signs, although it has some limitations, including its low sensitivity especially for the elderly or obstetric patients [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”