SPC365

ALERT score: a novel tool to predict adverse outcomes in cardiogenic shock during catheterization

Session: Sessão de Posters 23 - Choque cardiogénico: preditores, suporte e desfechos
Speaker: Mariana Duarte Almeida

Congress: CPC 2026
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.2 Acute Cardiac Care – Prehospital and Emergency Department Care
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Mariana Duarte Almeida; João Gouveia Fiuza; Francisco Rodrigues Santos; Gonçalo RM Ferreira; Oliver Correia Kungel; Luís Afonso Santos; Nuno Craveiro

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="color:black">Introduction:</span></strong><span style="color:black"> Cardiogenic shock complicates ~10% of acute myocardial infarctions, with an estimated mortality of 40&ndash;50%. Although evidence remains limited, mechanical circulatory support devices may improve outcomes in this setting. Identifying which patients would benefit from mechanical support versus those adequately managed with medical therapy alone remains challenging.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="color:black">Purpose:</span></strong><span style="color:black"> To identify pre-catheterization predictors of adverse outcomes and develop a scoring system to aid in early identification of patients who may require mechanical circulatory support.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="color:black">Methods:</span></strong><span style="color:black"> Retrospective data from</span>&nbsp;<strong><span style="color:black">January 2023 to June 2025</span></strong>&nbsp;<span style="color:black">were collected for catheterizations requiring</span>&nbsp;<strong><span style="color:black">intra-procedural vasopressors</span></strong><span style="color:black">. Demographic, clinical, and laboratory data available prior to catheterization were collected from medical records. The primary composite endpoint comprised intraprocedural death, in-hospital death, or sustained shock &gt;24 hours. Group comparisons were conducted using Chi-square and Mann-Whitney U tests, with p&lt;0.05 considered statistically significant. Significant variables informed the</span>&nbsp;<strong><span style="color:black">ALERT Score</span></strong><span style="color:black">. Logistic regression evaluated score-outcome associations, and predictive performance was assessed via receiver operating characteristic (ROC) curve analysis and area under the curve (AUC).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="color:black">Results:</span></strong><span style="color:black"> A total of 51 patients were included, 43 (84.3%) undergoing urgent procedures; 17 women (33.3%), with a mean age of 68.5 &plusmn; 11.6 years. The composite endpoint occurred in 21 (41.2%). Adverse outcomes were associated with age, DBP, heart rate, lactate, procedural urgency, and Killip class. ROC cut-offs: age &gt;69.5y (Sn 71.4%, Sp 70%), DBP &lt;57 mmHg (Sn 100%, Sp 73.7%), HR &gt;92.5 bpm (Sn 47.4%, Sp 87%), lactate &gt;2.2 mmol/L (Sn 77.8%, Sp 83.3%). The</span>&nbsp;<strong><span style="color:black">ALERT Score</span></strong>&nbsp;<span style="color:black">(0&ndash;6) assigned 1 point per criterion: age &ge;70 years, DBP &lt;57 mmHg, HR &ge;93 bpm, urgent procedure, Killip &ge;III, lactate &gt;2.2 mmol/L.</span>&nbsp;<span style="color:black">Patients with adverse outcomes had higher scores (3.3 &plusmn; 1.4 vs. 1.2 &plusmn; 0.9; p&lt;0.001). Higher scores strongly predicted the composite endpoint (OR 4.86; p&lt;0.001, 95% CI 2.05&ndash;11.5).</span> <span style="color:black">ROC analysis showed excellent discrimination (AUC 0.886; p&lt;0.001; 95% CI: 0.794&ndash;0.977).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="color:black">Conclusion:</span></strong><span style="color:black"> The ALERT Score, based on six pre-catheterization variables, predicts adverse outcomes in patients needing intra-procedural vasopressors and may guide early mechanical support decisions.&nbsp;Larger prospective studies are needed to validate the score and determine its role in guiding mechanical support implementation.</span></span></span></span></p>