Value Of Modified Shock Index For Predicting Short-Term Outcomes In Patients With ST-Segment Elevation Myocardial Infarction

Subject:The aim of this study was to evaluate the predictive values of modified shock index for short-term outcome in patients with ST-segment elevation myocardial infarction.Methods:This study included 263 consecutive patients with STEMI and emergency percutaneous coronary intervention.All clinical data were collected on admission.The blood pressure and heart rate were used to calculate SI and MSI,and the TIMI risk score was calculated according to the score criterion. The discriminatory capacity of TIMI 、 SI and SI for predicting 7-days major adverse cardiovascular events was assessed using the area under the receiver operating characteristic curve.The best cutoff of MSI for predicting 7-days MACE was also calculated by ROC curve,and patients were divided into 2 groups based on the best cutoff, the 7-days and 30-days MACE were observed.Then multivariate Logistic regression were performed to filter risk factors which influenced the prognosis.Results:1.There were totally 263 patients with STEMI and emergency percutaneous coronary intervention,included 220 males and arranged from 37 to 88 years old.MACE group is higher than without MACE group in TIMI、SI and MSI score(P<0.05).The C statistic of 3 risk score for predicting 7-days MACE were more than0.7,and there wre no discriminatory between 3 risk score(P>0.05).2.The best cutoff of MSI for predicting 7-day MACE was 1.3(AUC0.718,95%CI 0.638-0.797,P < 0.01). Patients were divided into 2 groups with increased MSI and decreased MSI,based on the best cutoff,the increased MSI group had significantly higher age than decreased MSI group(63.1±12.8 vs 68.7±13.5,P<0.01).During 7-day and 30-day follow up,48 and 59 MACE occured, and the increased MSI group had higher MACE rates(37.1% vs 7.6%,P < 0.5;37.1% vs7.6%,P<0.5)3.The 7-day MACE group is higher than without MACE group in age(74.8±10.7vs 62.8±12.8,P<0.01)、hypertension disease rate(56.8% vs 40.3%,P<0.05)、heart rate(93.1±23.9 vs 80.2±16.4,P<0.01)、Killip classification≥II(41.7% vs 8.7%,P<0.05)、MSI score(1.36±0.26 vs 1.07±0.24,P<0.01)and is lower SBP(120.7±25.2vs 111.7±19.2,P<0.05)、DBP(74.5±14.8 vs 70.2±14.5,P<0.05).4.Multivariate logistic regression analysis showed that increased age(OR1.07,95%CI 1.032-1.121,P < 0.01),admission glucose(OR 1.217,95%CI1.081-1.370,P<0.05),MSI score(OR 3.615,95%CI 1.213-10.667,P<0.05)were associated with 7-day MACE.And there was weak correlation between MSI and age(r=0.223,P<0.01),but had no significant correlation between MSI and admission glucose(P>0.05).Conclusions:Admission TIMI, SI and MSI could predict the MACE rates within acute phase in patients with STEMI and received PCI,but MSI may be more simple and reliable.