The Value Of Multi-factor Combined Evaluation Model In Predicting Hospital Death In Patients With Cardiogenic Shock After Myocardial Infarction

Objectives:To explore the risk factors of hospital death in patients with cardiogenic shock(CS)after acute myocardial infarction(AMI)and the value of multi-factor combined index evaluation model in predicting hospital death in patients with CS after AMI.To explore the predictive value of IABP-SHOCKII score and CSP score in hospital death of CS patients with percutaneous coronary intervention(PCI)after AMI.Methods:1.A total of 271 patients with CS after AMI treated in the Department of Cardiology,the first Hospital of Jilin University from January 2019 to November 2022 were collected.According to their in-hospital survival,the patients were divided into two groups: death group(n = 90)and survival group(n = 181).The independent influencing factors of hospital death were analyzed and a combined index prediction model was established.The predictive efficiency of joint index,single independent factor and CSP score was evaluated by receiver operating characteristic(ROC)curve and area under curve(AUC).Finally,the AUC of different indexes were compared.2.One hundred and ninety-nine patients with PCI were selected from 271 patients with CS after AMI.They were also divided into two groups: death group(n = 49)and survival group(n = 150).The predictive value of combined index,IABP-SHOCK II,CSP and IABP-SHOCK II+CSP score was evaluated by ROC and AUC.Finally,the AUC of different indexes were compared.Results:1.Univariate analysis showed that there were significant differences in unconsciousness,left ventricular ejection fraction(LVEF),mechanical complications,white blood cell(WBC),neutrophil absolute value(NE),monocyte absolute value(MO),Potential of hydrogen(PH),lactic acid(LAC),base excess(BE),aspartate aminotransferase(AST),alanine aminotransferase(ALT),direct bilirubin(DBIL),albumin(ALB),blood urea nitrogen(BUN),serum creatinine(Scr),estimated Glomerular Filtration Rate(EGFR),B-type brain natriuretic peptide(BNP),more than two vasoactive drugs,continuous renal replacement therapy(CRRT),invasive ventilator-assisted ventilation,successful reperfusion and CSP score between the two groups.2.Multivariate regression analysis showed that mechanical complications(OR=6.824,P<0.001),LAC(OR=1.125,P=0.006),Scr(OR=1.005,P=0.013),two or more vasoactive drugs(OR=5.163,P<0.001)and invasive ventilator-assisted ventilation(OR=2.823,P=0.004)were independent risk factors for hospital death in patients with CS after AMI,and successful reperfusion(OR=0.19,P<0.001)was an independent protective factor.2.In the patients with CS after AMI,the AUC of combined index prediction model and CSP score were 0.884 and 0.733,respectively.The sensitivity and specificity of the combined index prediction model and CSP score were 77.8% and 87.29%,86.67% and53.59%,respectively.3.The AUC of combined index prediction model,IABP-SHOCK II,CSP and IABP-SHOCK II+CSP scores in CS patients with PCI after AMI were 0.855,0.775,0.743 and 0.822,respectively.The sensitivity and specificity of the joint index prediction model,IABP-SHOCK II,CSP and IABP-SHOCK II+CSP scores were 85.71% and 80.67%,71.43% and 74%,93.88% and 52.67%,87.76% and 66%,respectively.Conclusion:1.Mechanical complications,LAC,Scr,more than two vasoactive drugs and invasive ventilator-assisted ventilation are independent risk factors of hospital death in patients with CS after AMI,and successful reperfusion is an independent protective factor.2.The combined index is of good value in predicting death in patients with CS after AMI,which is better than single independent influencing factor and CSP score.3.For the CS patients with PCI after AMI,the predictive value of IABP-SHOCKII and CSP scores was similar,while the combined index was better than IABP-SHOCKII,CSP and IABP-SHOCKII+CSP scores.