Auffret et al reported the ORBI score for evaluating a patient with an ST-segment elevation acute myocardial infarction (STEMI) who has been treated with a percutaneous coronary intervention (PCI). This can identify a patient at risk for cardiogenic shock while in the hospital. The authros are from the ORBI and RICO Working Groups.
Patient selection: acute STEMI treated with PCI, Killip class I to III
Parameters:
(1) age in years
(2) history of stroke or TIA
(3) cardiac arrest upon admission
(4) anterior STEMI
(5) first medical contact to PCI time in minutes
(6) Killip class
(7) heart rate in beats per minute
(8) systolic blood pressure and pulse pressure
(9) blood glucose iin mmol/L on admission
(10) culprit lesion in left main coronary artery
(11) post-PCI TIMI flow grade (0, 1, 2, 3)
|
Parameter
|
Finding
|
Points
|
|
age
|
<= 70 years
|
0
|
|
|
> 70 years
|
2
|
|
previous stroke or TIA
|
no
|
0
|
|
|
yes
|
2
|
|
cardiac arrest on admission
|
no
|
0
|
|
|
yes
|
3
|
|
anterior STEMI
|
no
|
0
|
|
|
yes
|
1
|
|
time to PCI
|
<= 90 minutes
|
0
|
|
|
> 90 minutes
|
2
|
|
Killip class
|
Killip I
|
0
|
|
|
Killip II
|
2
|
|
|
Killip III
|
6
|
|
heart rate
|
<= 90 beats per minute
|
0
|
|
|
> 90 beats per minute
|
3
|
|
systolic blood and pulse pressures
|
systolic < 125 mm Hg and pulse < 45 mm Hg
|
4
|
|
|
other
|
0
|
|
blood glucose on admission
|
<= 10 mmol/L
|
0
|
|
|
> 10 mmol/L
|
3
|
|
culprit artery
|
left main
|
5
|
|
|
other
|
0
|
|
post PCI TIMI flow
|
3 or 4
|
0
|
|
|
< 3
|
5
|
total score =
= SUM(points for all 11 parameters)
Interpretaton:
• minimum score: 0
• maximum score: 36
• The higher the score the greater the risk for cardiogenic shock.
The data in Figure 3 shows:
|
Score
|
Percent with Cardiac Arrest
|
|
0 to 2
|
< 1%
|
|
3 to 5
|
1-2%
|
|
6 to 24
|
(0.1899 * ((score)^2)) - (1.293 * (score)) + 2.284
|
|
> 24
|
> 80%
|
