{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:58:25Z","timestamp":1780099105526,"version":"3.54.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T00:00:00Z","timestamp":1598918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T00:00:00Z","timestamp":1598918400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100002383","name":"king saud university","doi-asserted-by":"publisher","award":["Research group number: RG -1436-013"],"award-info":[{"award-number":["Research group number: RG -1436-013"]}],"id":[{"id":"10.13039\/501100002383","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,9,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background:<\/jats:title>\n                  <jats:p>Shock index is a bedside reflection of integrated response of the cardiovascular and nervous systems. We aimed to evaluate the utility of shock index (heart rate\/systolic blood pressure) in patients presenting with acute coronary syndrome (ACS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods:<\/jats:title>\n                  <jats:p>We analyzed pooled data from seven Arabian Gulf registries; these ACS registries were carried out in seven countries (Qatar, Bahrain, Kuwait, UAE, Saudi Arabia, Oman and Yemen) between 2005 and 2017. A standard uniform coding strategy was used to recode each database using each registry protocol and clinical research form. Patients were categorized into two groups based on their initial shock index (low vs. high shock index). Optimal shock index cutoff was determined according to the receiver operating characteristic curve (ROC). Primary outcome was hospital mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>A total of 24,636 ACS patients met the inclusion criteria with a mean age 57\u00b113 years. Based on ROC analysis, the optimal shock index was 0.80 (83.5% had shock index &amp;lt;0.80 and 16.5% had shock index \u22650.80). In patients with high shock index, 55% had ST-elevation myocardial infarction and 45% had non-ST-elevation myocardial infarction. Patients with high shock index were more likely to have diabetes mellitus, late presentation, door to electrocardiogram &amp;gt;10 min, symptom to Emergency Department &amp;gt; 3 h, anterior myocardial infarction, impaired left ventricular function, no reperfusion post-therapy, recurrent ischemia\/myocardial infarction, tachyarrhythmia and stroke. However, high shock index was associated significantly with less chest pain, less thrombolytic therapy and less primary percutaneous coronary intervention. Shock index correlated significantly with pulse pressure (r= \u22120.52), mean arterial pressure (r= \u22120.48), Global Registry of Acute Coronary Events score (r =0.41) and Thrombolysis In Myocardial Infarction simple risk index (r= \u22120.59). Shock index \u22650.80 predicted mortality in ACS with 49% sensitivity, 85% specificity, 97.6% negative predictive value and 0.6 negative likelihood ratio. Multivariate regression analysis showed that shock index was an independent predictor for in-hospital mortality (adjusted odds ratio (aOR) 3.40, p&amp;lt;0.001), heart failure (aOR 1.67, p&amp;lt;0.001) and cardiogenic shock (aOR 3.70, p&amp;lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions:<\/jats:title>\n                  <jats:p>Although shock index is the least accurate of the ones tested, its simplicity may argue in favor of its use for early risk stratification in patients with ACS. The utility of shock index is equally good for ST-elevation myocardial infarction and non-ST-elevation acute coronary syndrome. High shock index identifies patients at increased risk of in-hospital mortality and urges physicians in the Emergency Department to use aggressive management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1177\/2048872619886307","type":"journal-article","created":{"date-parts":[[2019,11,8]],"date-time":"2019-11-08T17:23:51Z","timestamp":1573233831000},"page":"546-556","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Utility of shock index in 24,636 patients presenting with acute coronary syndrome"],"prefix":"10.1093","volume":"9","author":[{"given":"Ayman","family":"El-Menyar","sequence":"first","affiliation":[{"name":"Clinical Medicine, Weill Cornel Medical College, Doha, Qatar"},{"name":"Clinical Research, Hamad General Hospital, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid F","family":"Al Habib","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, KSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Zubaid","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alawi A","family":"Alsheikh-Ali","sequence":"additional","affiliation":[{"name":"College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadhim","family":"Sulaiman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael","family":"Almahmeed","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitham","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"AlMotarreb","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Sana\u2019a University, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anhar","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, KSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jassim Al","family":"Suwaidi","sequence":"additional","affiliation":[{"name":"Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,1]]},"reference":[{"key":"2021020117055690900_bibr1-2048872619886307","volume-title":"Chest pain of recent onset: Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin","author":"National Guideline Centre","year":"2010"},{"key":"2021020117055690900_bibr2-2048872619886307","volume-title":"Qatar health report. 2013","author":"Supreme Council of Health (SCH)","year":"2014"},{"key":"2021020117055690900_bibr3-2048872619886307","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/j.amjcard.2014.07.062","article-title":"Usefulness of the admission shock index for predicting short-term outcomes in patients with ST-segment elevation myocardial infarction","volume":"114","author":"Huang","year":"2014","journal-title":"Am J Cardiol"},{"key":"2021020117055690900_bibr4-2048872619886307","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.cjca.2011.07.008","article-title":"Shock index: A simple clinical parameter for quick mortality risk assessment in acute myocardial infarction","volume":"27","author":"Bilkova","year":"2011","journal-title":"Can J Cardiol"},{"key":"2021020117055690900_bibr5-2048872619886307","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/j.ajem.2015.04.066","article-title":"Modified shock index is a predictor for 7-day outcomes in patients with STEMI","volume":"33","author":"Shangguan","year":"2015","journal-title":"Am J Emerg Med"},{"key":"2021020117055690900_bibr6-2048872619886307","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1177\/2048872614561480","article-title":"Shock-index as a novel predictor of long-term outcome following primary percutaneous coronary intervention","volume":"4","author":"Spyridopoulos","year":"2015","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2021020117055690900_bibr7-2048872619886307","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1253\/circj.CJ-16-0616","article-title":"Zwolle Myocardial Infarction Study Group. Shock index more sensitive than cardiogenic shock in ST-elevation myocardial infarction treated by primary percutaneous coronary intervention","volume":"81","author":"Hemradj","year":"2017","journal-title":"Circ J"},{"key":"2021020117055690900_bibr8-2048872619886307","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1253\/circj.CJ-15-1135","article-title":"Shock index as a predictor of myocardial damage and clinical outcome in ST-elevation myocardial infarction","volume":"80","author":"Reinstadler","year":"2016","journal-title":"Circ J"},{"key":"2021020117055690900_bibr9-2048872619886307","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.amjms.2016.09.003","article-title":"Shock index as a predictor of myocardial injury in ST-segment elevation myocardial infarction","volume":"352","author":"Hwang","year":"2016","journal-title":"Am J Med Sci"},{"key":"2021020117055690900_bibr10-2048872619886307","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.carrev.2016.02.015","article-title":"Shock index as a predictor for in-hospital mortality in patients with non-ST segment elevation myocardial infarction","volume":"17","author":"Kobayashi","year":"2016","journal-title":"Cardiovasc Revasc Med"},{"issue":"4","key":"2021020117055690900_bibr11-2048872619886307","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/0003319716653885","article-title":"Long-term prognostic implications of the admission shock index in patients with acute myocardial infarction who received percutaneous coronary intervention","volume":"68","author":"Abe","year":"2017","journal-title":"Angiology"},{"key":"2021020117055690900_bibr12-2048872619886307","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/0300-9572(92)90006-X","article-title":"Shock index: A re-evaluation in acute circulatory failure","volume":"23","author":"Rady","year":"1992","journal-title":"Resuscitation"},{"key":"2021020117055690900_bibr13-2048872619886307","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1042\/CS20030376","article-title":"Sympathetic neural hyperactivity and its normalization following unstable angina and acute myocardial infarction","volume":"106","author":"Graham","year":"2004","journal-title":"Clin Sci (Lond)"},{"key":"2021020117055690900_bibr14-2048872619886307","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/S0008-6363(00)00308-4","article-title":"Sympathetic nerve sprouting, electrical remodeling and the mechanisms of sudden cardiac death","volume":"50","author":"Chen","year":"2001","journal-title":"Cardiovasc Res"},{"key":"2021020117055690900_bibr15-2048872619886307","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1038\/nature06798","article-title":"Tackling heart failure in the twenty-first century","volume":"451","author":"Mudd","year":"2008","journal-title":"Nature"},{"key":"2021020117055690900_bibr16-2048872619886307","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jsha.2011.05.004","article-title":"Baseline characteristics, management practices, and in-hospital outcomes of patients with acute coronary syndromes: Results of the Saudi project for assessment of coronary events (SPACE) registry","volume":"23","author":"AlHabib","year":"2011","journal-title":"J Saudi Heart Assoc"},{"key":"2021020117055690900_bibr17-2048872619886307","doi-asserted-by":"crossref","first-page":"e55508","DOI":"10.1371\/journal.pone.0055508","article-title":"Gender disparities in the presentation, management and outcomes of acute coronary syndrome patients: Data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2)","volume":"8","author":"Shehab","year":"2013","journal-title":"PLoS One"},{"key":"2021020117055690900_bibr18-2048872619886307","doi-asserted-by":"crossref","first-page":"41","DOI":"10.4103\/HEARTVIEWS.HEARTVIEWS_113_16","article-title":"Disparity in ST-segment elevation myocardial infarction practices and outcomes in Arabian Gulf countries (Gulf COAST registry)","volume":"18","author":"Zubaid","year":"2017","journal-title":"Heart Views"},{"key":"2021020117055690900_bibr19-2048872619886307","doi-asserted-by":"crossref","first-page":"e0147385","DOI":"10.1371\/journal.pone.0147385","article-title":"Patient and system-related delays of emergency medical services use in acute ST-elevation myocardial infarction: Results from the third Gulf registry of acute coronary events (Gulf RACE-3Ps)","volume":"11","author":"AlHabib","year":"2016","journal-title":"PLoS One"},{"key":"2021020117055690900_bibr20-2048872619886307","doi-asserted-by":"crossref","first-page":"e0216551","DOI":"10.1371\/journal.pone.0216551","article-title":"The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program)","volume":"14","author":"Alhabib","year":"2019","journal-title":"PLoS One"},{"key":"2021020117055690900_bibr21-2048872619886307","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1016\/S0735-1097(01)01702-8","article-title":"American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes. A report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee)","volume":"38","author":"Cannon","year":"2001","journal-title":"J Am Coll Cardiol"},{"issue":"10","key":"2021020117055690900_bibr22-2048872619886307","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1177\/0003319719857560","article-title":"Shock index in patients presenting with acute heart failure: A multicenter multinational observational study","volume":"70","author":"El-Menyar","year":"2019","journal-title":"Angiology"},{"key":"2021020117055690900_bibr23-2048872619886307","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1016\/S0140-6736(01)06649-1","article-title":"A simple risk index for rapid initial triage of patients with ST-elevation myocardial infarction: An InTIME II substudy","volume":"358","author":"Morrow","year":"2001","journal-title":"Lancet"},{"key":"2021020117055690900_bibr24-2048872619886307","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.ahj.2008.12.010","article-title":"Thrombolysis in Myocardial Infarction (TIMI) Risk Index predicts long-term mortality and heart failure in patients with ST-elevation myocardial infarction in the TIMI 2 clinical trial","volume":"157","author":"Truong","year":"2009","journal-title":"Am Heart J"},{"key":"2021020117055690900_bibr25-2048872619886307","doi-asserted-by":"crossref","first-page":"2727","DOI":"10.1001\/jama.291.22.2727","article-title":"GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome: Estimating the risk of 6-month postdischarge death in an international registry","volume":"291","author":"Eagle","year":"2004","journal-title":"JAMA"},{"key":"2021020117055690900_bibr26-2048872619886307","doi-asserted-by":"crossref","first-page":"11929","DOI":"10.1038\/s41598-017-12180-2","article-title":"Derivation and validation of shock index as a parameter for predicting long-term prognosis in patients with acute coronary syndrome","volume":"7","author":"Yu","year":"2017","journal-title":"Sci Rep"},{"key":"2021020117055690900_bibr27-2048872619886307","doi-asserted-by":"crossref","first-page":"e8014","DOI":"10.1097\/MD.0000000000008014","article-title":"The prognostic value of shock index for the outcomes of acute myocardial infarction patients: A systematic review and meta-analysis","volume":"96","author":"Zhang","year":"2017","journal-title":"Medicine (Baltimore)"}],"container-title":["European Heart Journal. Acute Cardiovascular Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2048872619886307","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2048872619886307","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/ehjacc\/article-pdf\/9\/6\/546\/36165802\/ehjacc0546.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjacc\/article-pdf\/9\/6\/546\/36165802\/ehjacc0546.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:19:43Z","timestamp":1618877983000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjacc\/article\/9\/6\/546-556\/6125578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,1]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,9,1]]},"published-print":{"date-parts":[[2020,9,1]]}},"URL":"https:\/\/doi.org\/10.1177\/2048872619886307","relation":{},"ISSN":["2048-8734","2048-8726"],"issn-type":[{"value":"2048-8734","type":"electronic"},{"value":"2048-8726","type":"print"}],"subject":[],"published-other":{"date-parts":[[2020,9,1]]},"published":{"date-parts":[[2020,9,1]]}}}