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| Item Type: | Article |
|---|---|
| Title: | Sex-specific prediction of cardiogenic shock after acute coronary syndromes: the SEX-SHOCK score |
| Creators Name: | Wang, Y., Zeller, M., Auffret, V., Georgiopoulos, G., Räber, L., Roffi, M., Templin, C., Muller, O., Liberale, L., Ministrini, S., Stamatelopoulos, K., Stellos, K., Camici, G.G., Montecucco, F., Rickli, H., Maza, M., Radovanovic, D., Cottin, Y., Chague, F., Niederseer, D., Lüscher, T.F. and Kraler, S. |
| Abstract: | BACKGROUND AND AIMS: Cardiogenic shock (CS) remains the primary cause of in-hospital death after acute coronary syndromes (ACS), with its plateauing mortality rates approaching 50%. To test novel interventions, personalized risk prediction is essential. The ORBI (Observatoire Régional Breton sur l'Infarctus) score represents the first-of-its-kind risk score to predict in-hospital CS in ACS patients undergoing percutaneous coronary intervention (PCI). However, its sex-specific performance remains unknown, and refined risk prediction strategies are warranted. METHODS: This multinational study included a total of 53 537 ACS patients without CS on admission undergoing PCI. Following sex-specific evaluation of ORBI, regression and machine-learning models were used for variable selection and risk prediction. By combining best-performing models with highest-ranked predictors, SEX-SHOCK was developed, and internally and externally validated. RESULTS: The ORBI score showed lower discriminative performance for the prediction of CS in females than males in Swiss (area under the receiver operating characteristic curve [95% confidence interval]: 0.78 [0.76-0.81] vs. 0.81 [0.79-0.83]; P =.048) and French ACS patients (0.77 [0.74-0.81] vs. 0.84 [0.81-0.86]; P = .002). The newly developed SEX-SHOCK score, now incorporating ST-segment elevation, creatinine, C-reactive protein, and left ventricular ejection fraction, outperformed ORBI in both sexes (females: 0.81 [0.78-0.83]; males: 0.83 [0.82-0.85]; P < .001), which prevailed following internal and external validation in RICO (females: 0.82 [0.79-0.85]; males: 0.88 [0.86-0.89]; P < .001) and SPUM-ACS (females: 0.83 [0.77-0.90], P = .004; males: 0.83 [0.80-0.87], P = .001). CONCLUSIONS: The ORBI score showed modest sex-specific performance. The novel SEX-SHOCK score provides superior performance in females and males across the entire spectrum of ACS, thus providing a basis for future interventional trials and contemporary ACS management. |
| Keywords: | Cardiogenic Shock, Acute Coronary Syndromes, Atherosclerosis, Personalized Risk Prediction, Inflammation, C-Reactive Protein, LVEF, Percutaneous Coronary Intervention, Machine Learning, Random Forest, Multilayer Perceptron, Gender Medicine, Precision Medicine |
| Source: | European Heart Journal |
| ISSN: | 0195-668X |
| Publisher: | Oxford University Press |
| Volume: | 45 |
| Number: | 43 |
| Page Range: | 4564-4578 |
| Date: | 14 November 2024 |
| Official Publication: | https://doi.org/10.1093/eurheartj/ehae593 |
| PubMed: | View item in PubMed |
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