RESUMEN
BACKGROUND: The shock index (SI), reflecting heart rate (HR) to SBP ratio, is established for predicting adverse outcomes in acute coronary syndrome (ACS) patients. Exploring the age shock index (ASI), obtained by multiplying SI with age, could offer further insights into ACS prognosis. OBJECTIVES: Assess ASI's effectiveness in predicting in-hospital death in individuals with ACS. METHODS: This study encompassed patients with acute myocardial infarction, drawn from a national registry spanning October 2010 to January 2022. The optimal ASI threshold was established using receiver operating characteristic (ROC) curve analysis. The primary outcome was in-hospital mortality. RESULTS: A total of 27 312 patients were enrolled, exhibiting a mean age of 66â ±â 13 years, with 72.3% being male and 47.5% having ST-elevation myocardial infarction. ROC analysis yielded an area under the curve (AUC) of 0.80, identifying the optimal ASI cutoff as 44. Multivariate regression analysis, adjusting for potential confounders, established ASIâ ≥â 44 as an independent predictor of in-hospital death [hazard ratio: 3.09, 95% confidence interval: 2.56-3.71, P â <â 0.001]. Furthermore, ASI emerged as a notably superior predictor of in-hospital death compared to the SI (AUC ASI â =â 0.80 vs. AUC SI â =â 0.72, P â <â 0.0001), though it did not outperform the Global Registry of Acute Coronary Events (GRACE) score (AUC ASI â =â 0.80 vs. AUC GRACE â =â 0.85, P â <â 0.001) or thrombolysis in myocardial infarction (TIMI) risk index (AUC ASI â =â 0.80 vs. AUC TIMI â =â 0.84, P â <â 0.001). CONCLUSION: The ASI offers an expedient mean to promptly identify ACS patients at elevated risk of in-hospital death. Its simplicity and effectiveness could render it a valuable tool for early risk stratification in this population.
Asunto(s)
Síndrome Coronario Agudo , Mortalidad Hospitalaria , Sistema de Registros , Humanos , Masculino , Femenino , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/diagnóstico , Anciano , Persona de Mediana Edad , Medición de Riesgo/métodos , Pronóstico , Factores de Edad , Factores de Riesgo , Frecuencia Cardíaca/fisiología , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/terapia , Curva ROC , Presión SanguíneaRESUMEN
BACKGROUND: Cardiac tumors have heterogeneous and unspecific clinical presentations which is why their diagnosis is difficult. CASE REPORT: A middle-aged woman presented to the emergency department with unspecific symptoms developing over 2 weeks. Multimodality imaging revealed a large mass filling the left atrium with a large base adherent to the fossa ovalis and flow obstruction. After surgical extraction, the anatomopathological analysis was compatible with a primary benign cardiac tumor. CONCLUSION: Clinical presentation of cardiac tumors is usually unspecific and multimodality imaging is crucial in the diagnostic workflow. Surgical excision should be performed as quickly as possible.
