# Prognostic performance of cardiogenic shock 4 proteins prediction model in infarct-related cardiogenic shock

## TL;DR

A protein-based risk score called CS4P helps predict outcomes in heart attack patients with cardiogenic shock, especially those with STEMI and no prior CPR.

## Contribution

The study shows CS4P has better prognostic performance in STEMI patients compared to NSTEMI and those with CPR history.

## Key findings

- CS4P score had higher predictive accuracy for STEMI patients (AUC 0.74) than NSTEMI patients (AUC 0.69).
- STEMI patients without CPR had better CS4P performance (AUC 0.78) than those with CPR (AUC 0.70).
- Higher CS4P tertile was linked to increased 30-day mortality (hazard ratio 1.42).

## Abstract

The aim of this analysis was to evaluate the prognostic features of the cardiogenic shock 4 proteins (CS4P) biomarker-based risk score in patients with cardiogenic shock (CS), presenting with ST-segment elevation myocardial infarction (STEMI) vs non-ST-segment elevation myocardial infarction (NSTEMI), with and without cardiopulmonary resuscitation (CPR).

The CS4P risk score, validated in cohorts of CS patients with both acute coronary syndrome (ACS) and non-ACS aetiologies, showed advanced predictive metrics compared with other contemporary risk prediction scores for CS. However, there is lack of data concerning the prognostic performance of the CS4P score among CS patients with different forms of ACS.

The present analysis is a post-hoc analysis of the randomized CULPRIT-SHOCK trial. The primary outcome was a composite of mortality or necessity for renal replacement therapy at 30-day follow-up. Cardiogenic shock 4 proteins markers were determined in serum using ELISA assays.

Of the 412 patients with CS included in this study, 240 (58.3%) patients had STEMI and 172 (41.7%) patients had NSTEMI. In CS patients presenting with STEMI, CS4P score exhibited better prognostication of the primary outcome compared with patients with NSTEMI [area under the curve (AUC) 0.74, 95% confidence interval (CI) 0.67–0.80 vs AUC 0.69, 95% CI 0.61–0.77; P = .05). Further, CS4P score displayed a higher prognostic performance in STEMI patients who had not undergone CPR prior to enrolment as compared with STEMI patients with preceding CPR (AUC 0.78; 95% CI 0.65–0.84 vs AUC 0.70, 95% CI 0.62–0.79; P < .001). Cardiogenic shock patients in the highest tertile of the CS4P risk score showed higher mortality rates within 30 days compared to those in the lowest tertile (hazard ratio 1.42, 95% CI 1.11–1.82; P = .005).

The CS4P score provides acceptable short-term mortality risk stratification among patients with CS due to acute myocardial infarction. The CS4P prediction model exhibits superior prognostication among CS patients with STEMI as compared to NSTEMI and in STEMI patients without CPR prior to hospital presentation.

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