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. 2021 Oct 27;10(8):869-877.
doi: 10.1093/ehjacc/zuab050.

Prognostic value of shock index in patients admitted with non-ST-segment elevation myocardial infarction: the ARIC study community surveillance

Zainali S Chunawala  1 , Michael E Hall  2 , Sameer Arora  3 , Xuming Dai  4 , Venu Menon  5 , Sidney C Smith  3 , Kunihiro Matsushita  6 , Melissa C Caughey  7
Affiliations

Prognostic value of shock index in patients admitted with non-ST-segment elevation myocardial infarction: the ARIC study community surveillance

Zainali S Chunawala et al. Eur Heart J Acute Cardiovasc Care. .

Abstract

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.

Keywords: Acute myocardial infarction; Epidemiology; Mortality; Risk score; NSTEMI.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Predictive accuracy of shock index, GRACE score, and TIMI risk score in prognosis of 28-day all-cause mortality, among patients admitted with non-ST-segment elevation myocardial infarction. The community surveillance component of the Atherosclerosis Risk in Communities Study, 2000–2014. GRACE, Global Registry of Acute Coronary Syndrome; ROC, receiver operating characteristic curve; TIMI, thrombolysis in myocardial ischaemia.
Figure 2
Figure 2
Predictive accuracy of shock index in prognosis of 28-day all-cause mortality, among various subgroups of patients admitted with non-ST-segment elevation myocardial infarction. The community surveillance component of the Atherosclerosis Risk in Communities Study, 2000–2014. ACEi/ARB, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker; AUC, area under the curve from receiver operating characteristics; CABG, coronary artery bypass graft; EMS, emergency medical services; PCI, percutaneous coronary intervention.
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