Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: The ORBI risk score

Aims To derive and validate a readily-useable risk score to identify patients at high-risk of in-hospital STEMI-related CS. Methods A total of 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire Regional Breton sur l’Infarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Cote-d’Or (RICO) constituted the external validation cohort. Stepwise multivariable logistic regression was used to build the score. Results Eleven variables were independently associated with the development of in-hospital CS: age > 70 years, prior stroke/transient ischemic attack, cardiac arrest upon admission, anterior STEMI, first medical contact-to-pPCI delay > 90 min, Killip class, heart rate > 90/min, a combination of systolic blood pressure   10 mmol/L, culprit lesion of the left main coronary artery, and post-pPCI Thrombolysis In Myocardial Infarction flow grade  Conclusion The ORBI risk score provides a readily useable and efficient tool to identify patients at high-risk of developing CS during hospitalization following STEMI, which may aid in further risk-stratification and thus potentially facilitate pre-emptive clinical decision making.