What is it about?
Older adults with ST-segment elevation myocardial infarction (STEMI) experience disproportionately high mortality despite advances in reperfusion therapy. The Shock Index (SI) and Age–Shock Index (ASI) offer rapid hemodynamic assessment but do not address hypoxia. The Hypoxia–Age–Shock Index (HASI), which incorporates oxygen saturation (SpO2), may improve early mortality prediction in geriatric STEMI.
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Why is it important?
This study addresses a critical and unmet need in the care of geriatric STEMI patients: despite advances in reperfusion therapy, older adults continue to experience disproportionately high mortality compared to their younger counterparts. As the global population ages, this issue will become increasingly pressing. Elderly patients often present with atypical symptoms, diminished physiological reserve, and multiple comorbidities, which complicate clinical assessment. Existing risk stratification tools, largely developed in younger cohorts, fail to capture the unique physiology of older adults, creating an urgent need for a rapid, objective tool to identify high-risk patients at the earliest point of care: triage. The Hypoxia-Age-Shock Index (HASI), which integrates oxygen saturation, age, and hemodynamic parameters into a single bedside-available index, offers a paradigm shift. Unlike traditional shock indices that consider only age or hemodynamics, HASI captures a broader spectrum of physiological derangement, particularly tissue hypoxia resulting from ventricular dysfunction or cardiogenic shock. This study provides the first systematic evaluation of HASI specifically in geriatric STEMI patients undergoing primary PCI, demonstrating its superior discriminative performance for in-hospital mortality compared to conventional indices. These findings confirm that hypoxia adds independent prognostic value beyond age and hemodynamics alone. The clinical importance of this work is substantial. HASI can be calculated immediately at triage using only vital signs, without waiting for laboratory results. This enables emergency physicians to rapidly identify high-risk elderly patients, mobilize resources earlier, activate catheterization teams proactively, and tailor treatment intensity to the patient's actual physiological status. By providing an objective, evidence-based tool that captures the true impact of the acute event, HASI may help reduce age-based disparities in treatment intensity and improve outcomes in this vulnerable population. This study not only fills a critical gap in the cardiovascular risk stratification literature but also provides a scientific foundation for integrating hypoxia assessment into routine triage practice, ultimately advancing the goal of equitable, high-quality care for all STEMI patients regardless of age.
Perspectives
This study's findings suggest several key directions for future research and clinical application. First, prospective multicenter validation is needed to confirm HASI's prognostic performance across diverse geriatric STEMI populations and healthcare settings. Second, integrating HASI into electronic triage systems could enable real-time risk alerts, prompting earlier activation of cardiac catheterization teams and intensive care resources. Third, mechanistic studies incorporating echocardiography and biomarkers should explore whether HASI primarily identifies occult cardiogenic shock, pulmonary congestion, or combined cardiopulmonary failure. Fourth, comparative effectiveness research should examine whether a sequential approach—using HASI for immediate triage followed by GRACE or TIMI scores for definitive assessment—optimizes both speed and accuracy. Fifth, investigations should determine whether HASI reduces age-based disparities by objectively identifying high-risk elderly patients who might otherwise be undertreated. Finally, the HASI framework may extend beyond STEMI to other acute cardiovascular conditions in elderly populations, such as NSTEMI, heart failure, or pulmonary embolism, where traditional indices underperform. The ultimate goal remains developing simple, accessible tools that enable early identification of high-risk geriatric patients and facilitate timely, appropriate interventions to improve outcomes in this vulnerable population.
Man-Ju Ruth Ting
Far Eastern Memorial Hospital
Read the Original
This page is a summary of: Use of the Hypoxia–Age–Shock Index at Triage to Predict Mortality in Geriatric STEMI Patients Undergoing Primary PCI, Medicina, February 2026, MDPI AG,
DOI: 10.3390/medicina62020365.
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