External validation and comparison of the CardShock and IABP-SHOCK II risk scores in real-world cardiogenic shock patients

Mercedes Rivas-Lasarte, Jordi Sans-Roselló, Elena Collado-Lledó, Víctor González-Fernández, Francisco J Noriega, Francisco J Hernández-Pérez, Juan Fernández-Martínez, Albert Ariza, Rosa-Maria Lidón, Ana Viana-Tejedor, Javier Segovia-Cubero, Veli-Pekka Harjola, Johan Lassus, Holger Thiele, Alessandro Sionis
European Heart Journal. Acute Cardiovascular Care 2020 January 31, : 2048872619895230

BACKGROUND: Mortality from cardiogenic shock remains high and early recognition and risk stratification are mandatory for optimal patient allocation and to guide treatment strategy. The CardShock and the Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock (IABP-SHOCK II) risk scores have shown good results in predicting short-term mortality in cardiogenic shock. However, to date, they have not been compared in a large cohort of ischaemic and non-ischaemic real-world cardiogenic shock patients.

METHODS: The Red-Shock is a multicentre cohort of non-selected cardiogenic shock patients. We calculated the CardShock and IABP-SHOCK II risk scores in each patient and assessed discrimination and calibration.

RESULTS: We included 696 patients. The main cause of cardiogenic shock was acute coronary syndrome, occurring in 62% of the patients. Compared with acute coronary syndrome patients, non-acute coronary syndrome patients were younger and had a lower proportion of risk factors but higher rates of renal insufficiency; intra-aortic balloon pump was also less frequently used (31% vs 56%). In contrast, non-acute coronary syndrome patients were more often treated with mechanical circulatory support devices (11% vs 3%, p <0.001 for both). Both risk scores were good predictors of in-hospital mortality in acute coronary syndrome patients and had similar areas under the receiver-operating characteristic curve (area under the curve: 0.742 for the CardShock vs 0.752 for IABP-SHOCK II, p =0.65). Their discrimination performance was only modest when applied to non-acute coronary syndrome patients (0.648 vs 0.619, respectively, p =0.31). Calibration was acceptable for both scores (Hosmer-Lemeshow p =0.22 for the CardShock and 0.68 for IABP-SHOCK II).

CONCLUSIONS: In our cohort, both the CardShock and the IABP-SHOCK II risk scores were good predictors of in-hospital mortality in acute coronary syndrome-related cardiogenic shock.

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