Predictive value of the intra-aortic balloon counterpulsation-shock Ⅱ score in the short-term prognosis of acute myocardial infarction complicated by cardiogenic shock in elderly patients / 中华老年医学杂志

ABSTRACT

Objective:To examine the predictive value of the intra-aortic balloon counterpulsation-shock Ⅱ(IABP-SHOCK Ⅱ)score for 30-day mortality of acute myocardial infarction(AMI)complicated by cardiogenic shock(CS)in elderly patients.Methods:Clinical data of 138 elderly patients with AMI complicated by CS admitted to our hospital and undergone IABP from January 2010 to January 2019 were retrospectively analyzed.According to the IABP-SHOCK Ⅱ score, they were divided into a low-risk group(scoring 0 to 2 points, 72 cases), a middle-risk group(scoring 3 to 4 points, 39 cases)and a high-risk group(scoring 5 to 9 points, 27 cases). Baseline data, drug therapy, interventional therapy, and IABP were used in the three groups.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of IABP-SHOCK Ⅱ for 30-day mortality.Results:Of the 138 patients, 71(51.4%)were male.There were significant differences in age, left ventricular end-diastolic diameter, left ventricular ejection fraction, levels of troponin, serum creatinine, urea nitrogen, B-type natriuretic peptide and lactic acid, Gensini score, rate of thrombolysis in myocardia infarction(TIMI)no-reflow, and rates of IABP insertion, invasive ventilation and bedside hemofiltration between the intermediate-risk group and the low-risk group and between the high-risk group and the low-risk group(each P<0.05). During hospitalization, proportions of patients receiving vasoactive drugs such as norepinephrine and dopamine in the three groups were similar(each P>0.05). After 30 days of follow-up, 25 patients(34.7%), 20 patients(51.3%), and 23 patients(85.2%)died in the low-risk group, the intermediate-risk group, and the high-risk group, respectively, with the Kaplan-Meier survival curve and the log-rank test showing statistically significant differences between the death rates(χ2=20.09, P<0.01). The ROC curve showed that the area under the curve was 0.883(95% CI 0.702~0.942, P<0.01). Conclusions:The IABP-SHOCK Ⅱ score may be used for short-term risk stratification after IABP implantation in elderly patients with AMI and CS.