MDCalc

Observatoire Régional Breton sur l’Infarctus (ORBI) Risk Score

Stratifies risk of in-hospital cardiogenic shock in patients undergoing primary percutaneous coronary intervention (PCI).

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This tool assesses cardiogenic shock risk. It is not related to ORBIT, which estimates bleeding risk in anticoagulated patients with atrial fibrillation.

Age, years

Previous stroke/

Presentation as cardiac arrest

Anterior myocardial infarction

First medical contact-to-primary delay

Killip class on admission

Heart rate on admission, beats/min

<125 mmHg and <45 mmHg on admission

Glucose on admission

Left main coronary artery culprit lesion

Post-primary PCI  flow

Result:

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Advice
  • A low score does not rule out subsequent cardiogenic shock and should not replace clinical assessment; continue post-PCI monitoring per institutional protocols and escalate care promptly if signs of shock develop.
  • This tool does not predict all post-STEMI cardiovascular risks, including mortality, and should not replace other early risk stratification tools (e.g., TIMI, GRACE).
Management
  • Lower-risk individuals: 
    • May be suitable for routine post-PCI monitoring per institutional protocols.
    • Reassess if clinical status changes.
  • Higher-risk individuals:
    • Plan for a higher level of care (ICU versus stepdown) post-PCI.
    • Institute more frequent hemodynamic and urine output monitoring.
    • Consider deferring or using caution with early initiation of therapies that may worsen hemodynamics in borderline patients (e.g., beta-blockers, ACE/ARBs), based on the overall clinical picture and local practice.
    • Engage the institutional “shock team” and consult advanced heart failure specialists early.
    • Establish an early plan for clinical deterioration, ensuring rapid access to vasopressor and inotropic support and mechanical circulatory support pathways.
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