TY - JOUR T1 - Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation JO - Revista Portuguesa de Cardiologia T2 - AU - Abreu,Glória AU - Azevedo,Pedro AU - Galvão Braga,Carlos AU - Vieira,Catarina AU - Álvares Pereira,Miguel AU - Martins,Juliana AU - Arantes,Carina AU - Rodrigues,Catarina AU - Salgado,Alberto AU - Marques,Jorge SN - 08702551 M3 - 10.1016/j.repc.2017.07.018 DO - 10.1016/j.repc.2017.07.018 UR - https://revportcardiol.org/pt-modified-shock-index-a-bedside-articulo-S0870255117301993 AB - IntroductionPrompt identification of higher-risk patients presenting with ST-segment elevation myocardial infarction (STEMI) is crucial to pursue a more aggressive approach. ObjectiveWe aimed to assess whether the modified shock index (MSI), the ratio of heart rate to mean arterial pressure, could predict six-month mortality among patients admitted with STEMI. MethodsA retrospective observational cohort study was performed in a single center including 1158 patients diagnosed with STEMI, without cardiogenic shock on admission, between July 2009 and December 2014. They were divided into two groups: group 1 – patients with MSI<0.93 (72%); group 2 – patients with MSI≥0.93 (28%). The primary endpoint was six-month all-cause mortality. ResultsMSI≥0.93 identified patients who were more likely to have signs of heart failure (p=0.002), anemia (p<0.001), renal insufficiency (p=0.014) and left ventricular systolic dysfunction (p=0.045). They more often required inotropic support (p<0.001), intra-aortic balloon pump (p<0.001) and mechanical ventilation (p<0.001). Regarding in-hospital adverse events, they had a higher prevalence of malignant arrhythmias (p=0.01) and mechanical complications (p=0.027). MSI≥0.93 was an independent predictor of overall six-month mortality (adjusted HR 2.00, 95% CI 1.20-3.34, p=0.008). ConclusionMSI was shown to be a valuable bedside tool which can rapidly identify high-risk STEMI patients at presentation. ER -