Sleeper et al developed several scores for evaluating a patient with acute myocardial infarction with cardiogenic shock. These can help to identify a patient who may benefit from more aggressive management. The authors are from New England Research Institutes, New York University, Auckland City Hospital, St. Paul's Hospital (Vancouver), and the University of Toronto.
Patient selection: acute myocardial infarction with cardiogenic shock
Outcome: in-hospital mortality at 30 days
The Stage 2 score can be used when invasive hemodynamic data is available.
Parameters:
(1) anoxic brain damage
(2) left ventricular ejection fraction (LVEF) in percent
(3) age in years
(4) end-organ hypoperfusion
(5) stroke work in grams per meter
Parameter
Finding
Points
anoxic brain damage
no
0
yes
25
LVEF
>= 28%
0
< 28%
8
age in years
<= 45 years
0
46 to 50 years
2
51 to 55 years
4
56 to 60 years
6
61 to 65 years
8
66 to 70 years
10
71 to 75 years
12
76 to 80 years
14
81 to 90 years
16
> 90 years
20
hypoperfusion
no
0
yes
14
stroke work
<= 5 g per m
18
6 to 15
15
16 to 25
12
26 to 35
9
36 to 45
6
46 to 55
3
> 55
0
where:
• The breakpoints for point assignment with age overlapped except at ends.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 85
• The higher the score the greater the mortality and the greater the benefit of early revascularization.
Total Score
Category
< 25
1
25 to 31
2
32 to 37
3
38 to 44
4
45 to 48
5
49 to 85
6
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