Editorial comment
Cardiogenic shock in acute myocardial infarction: Stratify to prevent
Choque cardiogénico no enfarte agudo do miocárdio: estratificar para prevenir
António José Fiarresga
Serviço de Cardiologia, Hospital de Santa Marta, CHLC, Lisboa, Portugal
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Jorge Marques" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Glória" "apellidos" => "Abreu" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Azevedo" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Galvão Braga" ] 3 => array:2 [ "nombre" => "Catarina" "apellidos" => "Vieira" ] 4 => array:2 [ "nombre" => "Miguel" "apellidos" => "Álvares Pereira" ] 5 => array:2 [ "nombre" => "Juliana" "apellidos" => "Martins" ] 6 => array:2 [ "nombre" => "Carina" "apellidos" => "Arantes" ] 7 => array:2 [ "nombre" => "Catarina" "apellidos" => "Rodrigues" ] 8 => array:2 [ "nombre" => "Alberto" "apellidos" => "Salgado" ] 9 => array:2 [ "nombre" => "Jorge" "apellidos" => "Marques" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117301993" "doi" => "10.1016/j.repc.2017.07.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117301993?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302022?idApp=UINPBA00004E" "url" => "/21742049/0000003700000006/v3_201807150625/S2174204918302022/v3_201807150625/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Cardiogenic shock in acute myocardial infarction: Stratify to prevent" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "489" "paginaFinal" => "490" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "António José Fiarresga" "autores" => array:1 [ 0 => array:3 [ "nombre" => "António José" "apellidos" => "Fiarresga" "email" => array:1 [ 0 => "a.fiarresga@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital de Santa Marta, CHLC, Lisboa, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Choque cardiogénico no enfarte agudo do miocárdio: estratificar para prevenir" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiogenic shock (CS) is defined as persistent hypotension (systolic blood pressure <90 mmHg) secondary to myocardial dysfunction, associated with signs of organ hypoperfusion. CS may be present in 10% of patients with ST-segment elevation myocardial infarction (STEMI) and is associated with 30-day mortality of about 50%.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In the majority of STEMI patients, hemodynamic deterioration occurs after hospital admission, which means that there may be room for preventive measures and highlights the importance of early recognition of those most likely to evolve to CS.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Scores such as Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC), Thrombolysis in Myocardial Infarction (TIMI), the Global Registry of Acute Coronary Events (GRACE) and the Zwolle risk score are used to stratify patients and enable the adoption of different levels of clinical monitoring, therapeutic care and post-discharge strategies.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> However, the search for simpler and more accurate scores has continued.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The shock index (SI) is defined as the ratio of heart rate to systolic blood pressure, and was introduced in 1967 by Allgower and Burri to assess the degree of hypovolemia in hemorrhagic or infectious shock states.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The SI, which is easy to calculate, is an objective measure of cardiovascular performance and a marker for predicting the onset of hypotension. Assessment of SI in the context of acute myocardial infarction was only used more recently, and a first meta-analysis, of eight studies enrolling 20<span class="elsevierStyleHsp" style=""></span>404 patients, was published last year.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> A high SI was associated with increased in-hospital mortality and higher risk of short- and long-term adverse outcomes compared to low SI.</p><p id="par0020" class="elsevierStylePara elsevierViewall">An important limitation of SI is the lack of information about systemic vascular resistance status. Mean arterial pressure (incorporating both systolic and diastolic blood pressure) best represents tissue perfusion status. The modified shock index (MSI), which is the ratio of heart rate to mean arterial pressure, has been shown to be a better predictor of mortality than heart rate, systolic blood pressure, diastolic blood pressure and SI alone in trauma patients.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Shangguan et al. were the first to assess the predictive value of MSI in the context of STEMI.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In a retrospective study of 160 consecutive patients, they found that MSI ≥1.4, assessed in the emergency department, was an independent factor for major adverse cardiac events and seven-day all-cause mortality, with a stronger association than SI. Yu et al. retrospectively studied 1864 STEMI patients undergoing primary coronary angioplasty to assess whether admission age SI (age multiplied by SI) and MSI were useful clinical parameters to predict long-term prognosis, with both showing good prognostic performance.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The cutoff value of MSI for the prediction of all-cause mortality was 0.71.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this issue of the Journal, Abreu et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> assess the prognostic value of MSI to predict six-month mortality in a large retrospective observational study of 1158 STEMI patients without cardiogenic shock on admission. They found that MSI ≥0.93 was present in about a quarter of the patients and was associated with worse in-hospital clinical course. Adverse events, acute heart failure and cardiogenic shock were significantly more frequent in this subgroup. MSI was also an independent predictor of overall six-month mortality. The cutoff of 0.93 identified by the authors is between those in the above studies, which presumably reflects methodological differences, such as population selection and the timing and method for assessing hemodynamic parameters. However, their approach of using MSI in patients with no shock at admission, and assessing heart rate and blood pressure in the hemodynamic laboratory, seems to be the most appropriate and practical way to apply this index in clinical practice.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Their study has limitations, some of which are acknowledged by the authors, including its single-center and retrospective design, the lack of a control group to effectively test their hypothesis, and the lack of comparison with other hemodynamic indices or risk scores. Nevertheless, the authors should be congratulated for their important contribution to an issue that is still poorly defined and that needs further investigation, since a simple risk stratification of these patients remains an unmet clinical need. They have paved the way for future studies that may validate this strategy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)" "etal" => true "autores" => array:3 [ 0 => "B. Ibanez" 1 => "S. James" 2 => "S. Agewall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehi093" "Revista" => array:4 [ "tituloSerie" => "Eur Heart J" "fecha" => "2017" "volumen" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15637085" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of cardiogenic shock in acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Khalid" 1 => "S. Dhakam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2174/157340308783565456" "Revista" => array:6 [ "tituloSerie" => "Curr Cardiol Rev" "fecha" => "2008" "volumen" => "4" "paginaInicial" => "34" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19924275" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Tralhão" 1 => "A.M. Ferreira" 2 => "S. Madeira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2015.04.006" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2015" "volumen" => "34" "paginaInicial" => "535" "paginaFinal" => "541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26297630" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "GRACE, TIMI Zwolle and CADILLAC risk scores – do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Kozieradzka" 1 => "K.A. Kamiński" 2 => "D. Maciorkowska" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2009.10.026" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2011" "volumen" => "148" "paginaInicial" => "70" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19923016" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shock index" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Allgower" 1 => "C. Burri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0028-1106070" "Revista" => array:6 [ "tituloSerie" => "Dtsch Med Wochenschr" "fecha" => "1967" "volumen" => "92" "paginaInicial" => "1947" "paginaFinal" => "1950" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5299769" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prognostic value of shock index for the outcomes of acute myocardial infarction patients: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "X. Zhang" 1 => "Z. Wang" 2 => "Z. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "2017" "volumen" => "96" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlation of shock index and modified shock index with the outcome of adult trauma patients: a prospective study of 9860 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Singh" 1 => "S. Ali" 2 => "A. Agarwal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/1947-2714.141632" "Revista" => array:6 [ "tituloSerie" => "N Am J Med Sci" "fecha" => "2014" "volumen" => "6" "paginaInicial" => "450" "paginaFinal" => "452" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25317389" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modified shock index is a predictor for 7-day outcomes in patients with STEMI" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Q. Shangguan" 1 => "J.S. Xu" 2 => "H. Su" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2015.04.066" "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "1072" "paginaFinal" => "1075" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25983270" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age shock index is superior to shock index and modified shock index for predicting long-term prognosis in acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Yu" 1 => "C. Tian" 2 => "J. Song" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SHK.0000000000000892" "Revista" => array:6 [ "tituloSerie" => "Shock" "fecha" => "2017" "volumen" => "48" "paginaInicial" => "545" "paginaFinal" => "550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28481840" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modified shock index: a bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Abreu" 1 => "P. Azevedo" 2 => "P.G. Braga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2017.07.018" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2018" "volumen" => "37" "paginaInicial" => "481" "paginaFinal" => "488" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29807676" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003700000006/v3_201807150625/S2174204918302034/v3_201807150625/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000006/v3_201807150625/S2174204918302034/v3_201807150625/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302034?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 8 | 17 |
| 2024 October | 36 | 21 | 57 |
| 2024 September | 49 | 25 | 74 |
| 2024 August | 43 | 23 | 66 |
| 2024 July | 37 | 30 | 67 |
| 2024 June | 32 | 20 | 52 |
| 2024 May | 46 | 21 | 67 |
| 2024 April | 28 | 27 | 55 |
| 2024 March | 31 | 16 | 47 |
| 2024 February | 31 | 22 | 53 |
| 2024 January | 24 | 24 | 48 |
| 2023 December | 17 | 29 | 46 |
| 2023 November | 35 | 20 | 55 |
| 2023 October | 22 | 18 | 40 |
| 2023 September | 14 | 20 | 34 |
| 2023 August | 26 | 13 | 39 |
| 2023 July | 22 | 8 | 30 |
| 2023 June | 23 | 11 | 34 |
| 2023 May | 42 | 27 | 69 |
| 2023 April | 18 | 4 | 22 |
| 2023 March | 40 | 20 | 60 |
| 2023 February | 24 | 18 | 42 |
| 2023 January | 21 | 13 | 34 |
| 2022 December | 44 | 16 | 60 |
| 2022 November | 31 | 24 | 55 |
| 2022 October | 43 | 25 | 68 |
| 2022 September | 34 | 29 | 63 |
| 2022 August | 30 | 35 | 65 |
| 2022 July | 36 | 44 | 80 |
| 2022 June | 28 | 32 | 60 |
| 2022 May | 16 | 26 | 42 |
| 2022 April | 38 | 38 | 76 |
| 2022 March | 37 | 36 | 73 |
| 2022 February | 32 | 32 | 64 |
| 2022 January | 25 | 22 | 47 |
| 2021 December | 32 | 33 | 65 |
| 2021 November | 32 | 31 | 63 |
| 2021 October | 27 | 52 | 79 |
| 2021 September | 28 | 27 | 55 |
| 2021 August | 33 | 36 | 69 |
| 2021 July | 23 | 25 | 48 |
| 2021 June | 27 | 16 | 43 |
| 2021 May | 37 | 45 | 82 |
| 2021 April | 41 | 49 | 90 |
| 2021 March | 56 | 24 | 80 |
| 2021 February | 84 | 17 | 101 |
| 2021 January | 39 | 15 | 54 |
| 2020 December | 40 | 19 | 59 |
| 2020 November | 26 | 15 | 41 |
| 2020 October | 13 | 18 | 31 |
| 2020 September | 59 | 12 | 71 |
| 2020 August | 21 | 5 | 26 |
| 2020 July | 40 | 12 | 52 |
| 2020 June | 41 | 15 | 56 |
| 2020 May | 25 | 21 | 46 |
| 2020 April | 38 | 19 | 57 |
| 2020 March | 46 | 12 | 58 |
| 2020 February | 108 | 44 | 152 |
| 2020 January | 39 | 8 | 47 |
| 2019 December | 34 | 13 | 47 |
| 2019 November | 23 | 10 | 33 |
| 2019 October | 55 | 13 | 68 |
| 2019 September | 24 | 7 | 31 |
| 2019 August | 16 | 7 | 23 |
| 2019 July | 42 | 12 | 54 |
| 2019 June | 28 | 21 | 49 |
| 2019 May | 44 | 4 | 48 |
| 2019 April | 213 | 16 | 229 |
| 2019 March | 29 | 11 | 40 |
| 2019 February | 64 | 11 | 75 |
| 2019 January | 27 | 5 | 32 |
| 2018 December | 61 | 11 | 72 |
| 2018 November | 51 | 14 | 65 |
| 2018 October | 90 | 22 | 112 |
| 2018 September | 31 | 17 | 48 |
| 2018 August | 83 | 28 | 111 |
| 2018 July | 51 | 26 | 77 |
| 2018 June | 27 | 14 | 41 |
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