This DANAMI-3 secondary analysis classified 1,574 STEMI patients without cardiogenic shock as high or low risk using the ORBI score. High-risk patients had greater inflammation and larger final infarcts, involving 15.7% versus 10.1% of left ventricular mass. Ten-year all-cause mortality was 41% versus 20%, with an adjusted hazard ratio of 1.47 (95% confidence interval 1.16–1.85). The adjusted mortality association was strongest within 30 days, while the score discriminated 10-year mortality less well than age alone, with areas under the curve of 0.67 versus 0.79.
ORBI-defined shock risk also marked higher long-term mortality and greater infarct burden in STEMI patients initially without shock. Its weaker discrimination than age alone limits its appeal as a stand-alone long-term prognostic tool.
Study limitation: These nonrandomized risk-group comparisons cannot establish causality or whether targeting inflammation improves outcomes.
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