SEX-SHOCK Risk Score for Cardiogenic Shock Development in ACS
Predicts risk of developing cardiogenic shock in patients presenting with acute coronary syndrome (ACS). Validated in STEMI and NSTEMI populations to identify high-risk patients for early intensive monitoring.
Score interpretation
SEX-SHOCK 0-1 -- low probability of developing cardiogenic shock during ACS admission
→ Standard ACS pathway: primary PCI if STEMI within 12 hours of symptom onset; dual antiplatelet therapy (aspirin + ticagrelor or prasugrel preferred; clopidogrel if high bleed risk); IV heparin or bivalirudin; statin loading (atorvastatin 80 mg); beta-blocker if no contraindication; ACEi/ARB within 24 hours; cardiac monitoring; regular observations; early mobilisation; cardiac rehabilitation referral; secondary prevention counselling.
SEX-SHOCK 2-3 -- intermediate risk; enhanced monitoring required
→ Enhanced monitoring: continuous ECG; hourly BP/HR; urine output monitoring; serial ECGs (12-lead every 2 hours first 12 hours); troponin at 0, 3, 6 hours; echo early (within 24 hours) to assess LV function; proactive fluid management; consider early senior cardiology review and consideration of temporary mechanical circulatory support (Impella or IABP) pre-PCI if clinical deterioration; optimise preload and afterload; avoid right heart compromise (RV infarct protocol if inferior STEMI).
SEX-SHOCK 4-6 -- high risk; immediate intensive monitoring and early intervention strategy
→ Cardiology consultant immediate review; consider mechanical circulatory support (MCS) proactively: intra-aortic balloon pump (IABP) or Impella 2.5/CP before or during PCI; invasive haemodynamic monitoring (Swan-Ganz catheter or PICCO); consider CCU admission from catheter lab; early echo in cath lab; complete revascularisation vs culprit-only PCI -- CULPRIT-SHOCK trial: staged PCI preferred for multivessel disease in shock; vasopressors: noradrenaline first-line if cardiogenic shock develops; avoid dopamine (SOAP-II trial); ensure phosphodiesterase inhibitors (milrinone) available; temperature management if OHCA; refer to ECMO centre if refractory to conventional MCS.
Interpretation bands for the SEX-SHOCK. Apply clinical judgement and local guidance.
References
- Pöss J et al. Development and validation of the SEX-SHOCK risk score to predict the development of cardiogenic shock in patients with ACS. JACC Cardiovascular Interventions. 2017;10(20):2084-2093.
- Ibanez B et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119-177.
Related
Curated clinical cross-links plus same-class fallbacks.
- Noradrenaline (Cardiogenic Shock / Vasopressor) · Vasopressor / Cardiogenic Shock
- Hydrocortisone (ICU — Stress Dosing) · Corticosteroid (ICU/Septic Shock)
- Alteplase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Streptokinase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Folinic Acid (Calcium Folinate / Leucovorin) · Antidote / Chemotherapy Support
- Vasopressin / Terlipressin · Vasopressin Analogue — Vasodilatory Shock / Variceal Bleeding
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.