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A score for decision making during percutaneous coronary intervention in acute myocardial infarction patients with
Hae Chang Jeong1, Joon Ho Ahn2, Min Chul Kim2
1Department of Cardiology, Cardiovascular Center, Miraero 21 Hospital, Gwangju, Korea.
Insights
A new CONVERSE score helps determine optimal percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) with multivessel disease (MVD). A score of 3 or higher suggests multivessel PCI is preferred for better outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Optimal percutaneous coronary intervention (PCI) strategy for acute myocardial infarction (AMI) with multivessel disease (MVD) remains debated.
- Individualized treatment decisions are crucial for improving patient outcomes in complex cardiac cases.
Purpose of the Study:
- To develop a simple tool for assessing an individualized and optimized PCI strategy in AMI patients with MVD.
- To identify predictors of major adverse cardiac events (MACEs) to guide revascularization decisions.
Main Methods:
- Analysis of 2,630 patients with AMI and MVD from the COREA-AMI registry (2004-2009).
- Subgroup analysis to develop the culprit only versus multivessel revascularization (CONVERSE) score based on independent predictors of MACEs.
- 1-year clinical follow-up to assess MACEs and validate the CONVERSE score.
Main Results:
- The CONVERSE score comprises eight independent variables including age, comorbidities, clinical status, renal function, inflammation markers, and culprit vessel characteristics.
- MACE incidence increased linearly with the CONVERSE score.
- A CONVERSE score cutoff of 3 points was identified as a threshold for decision-making.
Conclusions:
- Patients with AMI and MVD scoring 3 or more on the CONVERSE score are recommended for multivessel PCI.
- The CONVERSE score provides a simple, objective tool to guide PCI strategy selection in this patient population.
Background/Aims:
The optimal percutaneous coronary intervention (PCI) strategy in patients with acute myocardial infarction (AMI) with multivessel disease (MVD) is uncertain. This study was designed to develop a novel and simple tool for assessing an individualized and optimized PCI strategy in AMI patients with MVD.
Methods:
In total, 5,025 patients with AMI from nine centers at two universities were enrolled in the prospective Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction (COREA-AMI) registry from January 2004 through December 2009. From among them, we selected 2,630 patients with MVD who were treated by culprit-only or multivessel (MV) PCI. We investigated major adverse cardiac events (MACEs) during a 1-year clinical follow-up. Using a subgroup analysis, we extracted variables for use in the culprit only versus multivessel revascularization (CONVERSE) score, which showed a preference for MV PCI rather than culprit-only PCI for treating MVD.
Results:
The CONVERSE score was constructed using eight independent variables (1 point for each variable): age > 65 years, hypertension, diabetes mellitus, high Killip class (III or IV), low left ventricular ejection fraction (≤ 50%), low creatinine clearance (≤ 60 mL/min), high level of high-sensitivity C-reactive protein (≥ 2.0 mg/L), and left anterior descending artery or left main as the nonculprit vessel. The incidence of MACEs increased linearly with the CONVERSE score. The receiver operating characteristic curve showed that the cutoff value was 3 points.
Conclusion:
The results suggest that patients with a CONVERSE score of 3 or more should undergo MV PCI.
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