Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients

Shan Wang; You Zhang; Datun Qi; Xianpei Wang; Zhongyu Zhu; Wei Yang; Muwei Li; Dayi Hu; Chuanyu Gao

doi:10.1080/07853890.2024.2311854

Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients

Ann Med. 2024 Dec;56(1):2311854. doi: 10.1080/07853890.2024.2311854. Epub 2024 Feb 7.

Authors

Shan Wang^{1

2

3}, You Zhang^{1

2

3}, Datun Qi^{1

3}, Xianpei Wang^{1

3}, Zhongyu Zhu^{1

3}, Wei Yang^{1

3}, Muwei Li^{1

3}, Dayi Hu^{2

4}, Chuanyu Gao^{1

2

3}

Affiliations

¹ Department of Cardiology, Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China.
² Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China.
³ Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China.
⁴ Institute of Cardiovascular Disease, Peking University People's Hospital, Beijing, China.

Abstract

Background: The incidence of mortality is considerable after ST-elevation myocardial infarction (STEMI) hospitalization; risk assessment is needed to guide postdischarge management. Age shock index (SI) and age modified shock index (MSI) were described as useful prognosis instruments; nevertheless, their predictive effect on short and long-term postdischarge mortality has not yet been sufficiently confirmed.

Methods: This analysis included 3389 prospective patients enrolled from 2016 to 2018. Endpoints were postdischarge mortality within 30 days and from 30 days to 1 year. Hazard ratios (HRs) were evaluated by Cox proportional-hazards regression. Predictive performances were assessed by area under the curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision curve analysis (DCA) and compared with TIMI risk score and GRACE score.

Results: The AUCs were 0.753, 0.746 for age SI and 0.755, 0.755 for age MSI for short- and long-term postdischarge mortality. No significant AUC differences and NRI were observed compared with the classic scores; decreased IDI was observed especially for long-term postdischarge mortality. Multivariate analysis revealed significantly higher short- and long-term postdischarge mortality for patients with high age SI (HR: 5.44 (2.73-10.85), 5.34(3.18-8.96)), high age MSI (HR: 4.17(1.78-9.79), 5.75(3.20-10.31)) compared to counterparts with low indices. DCA observed comparable clinical usefulness for predicting short-term postdischarge mortality. Furthermore, age SI and age MSI were not significantly associated with postdischarge prognosis for patients who received fibrinolysis.

Conclusions: Age SI and age MSI were valuable instruments to identify high postdischarge mortality with comparable predictive ability compared with the classic scores, especially for events within 30 days after hospitalization.

Keywords: Age shock index; ST-elevation myocardial infarction; age modified shock index; clinical validation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aftercare
Humans
Infant
Patient Discharge
Prognosis
Prospective Studies
Retrospective Studies
Risk Assessment
ST Elevation Myocardial Infarction* / diagnosis

Grants and funding

This work was supported by the Project of Scientific and Technological Support Plan of Health and Family Planning Commission of Henan Province in 2021 [Grant Number LHGJ20210105], the Project of Scientific and Technological of Science and Technology Department of Henan Province in 2022 [Grant Number 222102310656], the Project of Scientific and Technological Support Plan of Health and Family Planning Commission of Henan Province in 2016 [Grant Number 201602210] and Shanghai Tasly Pharmaceutical Co. Ltd.