Background and Aims Cardiogenic shock (CS) remains the primary cause of in-hospital death after acute coronary syndromes (ACS), with its plateauing mortality rates approaching 50%. To test novel interventions, personalized risk prediction is essential. The ORBI (Observatoire Régional Breton sur l’Infarctus) score represents the first-of-its-kind risk score to predict in-hospital CS in ACS patients undergoing percutaneous coronary intervention (PCI). However, its sex-specific performance remains unknown, and refined risk prediction strategies are warranted. Methods This multinational study included a total of 53 537 ACS patients without CS on admission undergoing PCI. Following sex-specific evaluation of ORBI, regression and machine-learning models were used for variable selection and risk prediction. By combining best-performing models with highest-ranked predictors, SEX-SHOCK was developed, and internally and externally validated. Results The ORBI score showed lower discriminative performance for the prediction of CS in females than males in Swiss (area under the receiver operating characteristic curve [95% confidence interval]: 0.78 [0.76–0.81] vs. 0.81 [0.79–0.83]; P =.048) and French ACS patients (0.77 [0.74–0.81] vs. 0.84 [0.81–0.86]; P = .002). The newly developed SEX-SHOCK score, now incorporating ST-segment elevation, creatinine, C-reactive protein, and left ventricular ejection fraction, outperformed ORBI in both sexes (females: 0.81 [0.78–0.83]; males: 0.83 [0.82–0.85]; P < .001), which prevailed following internal and external validation in RICO (females: 0.82 [0.79–0.85]; males: 0.88 [0.86–0.89]; P < .001) and SPUM-ACS (females: 0.83 [0.77–0.90], P = .004; males: 0.83 [0.80–0.87], P = .001). Conclusions The ORBI score showed modest sex-specific performance. The novel SEX-SHOCK score provides superior performance in females and males across the entire spectrum of ACS, thus providing a basis for future interventional trials and contemporary ACS management.

中文翻译：

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急性冠脉综合征后心源性休克的性别特异性预测：-SHOCK 评分


背景和目标心源性休克 （CS） 仍然是急性冠脉综合征 （ACS） 后院内死亡的主要原因，其稳定死亡率接近 50%。为了测试新的干预措施，个性化的风险预测是必不可少的。ORBI （Observatoire Régional Breton sur l'Infarctus） 评分是预测接受经皮冠状动脉介入治疗 （PCI） 的 ACS 患者院内 CS 的首创风险评分。然而，其性别特异性表现仍然未知，因此需要改进的风险预测策略。方法 这项多国研究共纳入 53 537 例接受 PCI 的入院无 CS 的 ACS 患者。在对 ORBI 进行性别特异性评估后，使用回归和机器学习模型进行变量选择和风险预测。通过将性能最佳的模型与排名最高的预测因子相结合，开发了-SHOCK，并进行了内部和外部验证。结果 ORBI 评分显示，瑞士女性预测 CS 的判别性能低于男性（受试者工作特征曲线下面积 [95% 置信区间]：0.78 [0.76-0.81] vs. 0.81 [0.79-0.83];P =.048） 和法国 ACS 患者 （0.77 [0.74-0.81] vs. 0.84 [0.81-0.86];P = .002）。新开发的-SHOCK 评分，现在包括 ST 段升高、肌酐、C 反应蛋白和左心室射血分数，在两性中都优于 ORBI（女性：0.81 [0.78–0.83];男性：0.83 [0.82–0.85];P < .001），在 RICO 的内部和外部验证后占上风（女性：0.82 [0.79–0.85];男性：0.88 [0.86–0.89];P < .001）和 SPUM-ACS（女性：0.83 [0.77–0.90]，P = .004;男性：0.83 [0.80–0.87]，P = .001）。 结论 ORBI 评分显示适度的性别特异性表现。新颖的-SHOCK 评分在整个 ACS 范围内为女性和男性提供了卓越的表现，从而为未来的介入试验和当代 ACS 管理提供了基础。