EVALUATION OF CHA2DS2-VASC SCORE TO PREDICT CARDIOGENIC SHOCK IN ST ELEVATION MYOCARDIAL INFARCTION (STEMI)

Abstract

Objective:
To evaluate the ability of the CHA₂DS₂-VASc score to predict the likelihood of cardiogenic shock in patients diagnosed with ST-elevation myocardial infarction (STEMI).
Methodology:
The research was conducted at the Department of Cardiology, NICVD, Karachi, over the period from February 2023 and February 2024. A descriptive study design was employed. The study population included 531 patients diagnosed with STEMI, aged between 18 and 70 years, who presented within 24 hours of symptom onset. Participants were recruited using non-probability consecutive sampling. On clinical symptoms and ECG diagnosed STEMI12, patients who had past myocardial infarction, chronic kidney diseases, chronic liver diseases, heart failure, and arrhythmias were excluded. Before PCI, we collected baseline demographic and clinical information and determined CHA₂DS₂-VASc scores. SPSS version 26.0 was used for data analysis.
Results:
The mean±SD age of the individuals were found to be 57.05±11.283. Out of 531 participants, 82.3% were male, while 17.7% accounted for female. The CHA₂DS₂-VASc score effectively forecast cardiogenic shock in STEMI cases, alongside an AUC of 0.761 (p = 0.0001). Cases with greater scores faced worse in-hospital outcomes, including a significantly higher mortality rate (9.6% compared to 1.5%, p=0.0001) and more frequent major cardiovascular events (14.4% vs. 5.4%, p=0.001). Their average ejection fraction was also lower (41.43% vs. 46.06%, p = 0.0001).
Conclusion:
It is to be concluded that CHA₂DS₂-VASc score offers practical insights into risk assessment for STEMI patients, especially in predicting the likelihood of cardiogenic shock. Patients with higher scores tended to have more severe health conditions and poorer outcomes during hospitalization. Using this score in clinical settings helps identify those who may benefit from closer observation and timely interventions.
Keywords:
Area under the curve, Cardiogenic shock, CHA2DS2-VASc score, Hemodynamic complications, ST-segment elevation myocardial infarction,