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Published on: September 22, 2020
The CatLet score and outcome prediction in acute myocardial infarction for patients undergoing primary percutaneous
Ming-Xing Xu1, Terrence D Ruddy2, Paul Schoenhagen3
1Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, China.
Insights
The CatLet score effectively predicts adverse cardiac events in acute myocardial infarction patients, outperforming the SYNTAX score. This validated scoring system improves risk stratification for coronary artery disease outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- The Coronary Artery Tree description and Lesion EvaluaTion (CatLet) score is a novel system for assessing coronary artery disease complexity.
- Existing scoring systems lack comprehensive validation for risk stratification in acute myocardial infarction (AMI).
Purpose of the Study:
- To validate the CatLet score's ability to predict clinical outcomes in patients with AMI.
- To compare the CatLet score's performance against the established SYNTAX score for risk stratification.
Main Methods:
- Retrospective analysis of 308 patients with AMI undergoing primary percutaneous coronary intervention.
- CatLet score calculation and stratification into tertiles (low, mid, top).
- Primary endpoint: major adverse cardiac or cerebrovascular events (MACCEs) over a median 4.3-year follow-up.
Main Results:
- The CatLet score significantly predicted MACCEs, cardiac death, and all-cause death, even after adjusting for risk factors.
- CatLet score demonstrated superior discrimination and calibration compared to the SYNTAX score.
- Significant net reclassification improvement was observed for MACCEs (37.2%), cardiac death (35.5%), and all-cause death (31.8%).
Conclusions:
- The CatLet score is a validated and more specific tool for predicting outcomes in AMI patients.
- Its ability to account for coronary anatomy variability enhances its predictive accuracy.
- The CatLet score offers refined risk stratification for patients with coronary artery disease.
Background:
The Coronary Artery Tree description and Lesion EvaluaTion (CatLet) score accommodating the variability in coronary anatomy is a recently developed and comprehensive angiographic scoring system aimed at assisting in risk-stratification of patients with coronary artery disease. However, a validation of this angiographic scoring system is lacking.
Methods:
The CatLet score was calculated retrospectively in 308 consecutively enrolled patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention. The primary endpoint, major adverse cardiac or cerebrovascular events (MACCEs), was stratified according to CatLet tertiles: CatLetlow ≤14 (n = 124), CatLetmid 15-21 (n = 82) and CatLettop ≥22 (n = 102).
Results:
The CatLet score alone or after adjusting for a broad spectrum of risk factors, significantly predicted clinical outcomes at a median 4.3-year follow-up. Multivariable-adjusted hazard ratios (95%CI)/unit higher score were 1.05 (1.04-1.07) for MACCE, 1.06 (1.04-1.07) for cardiac death, and 1.05 (1.04-1.07) for all-cause death. When compared to the SYNTAX score, improved discrimination and better calibration of this CatLet score resulted in a significantly refined risk stratification. The overall category-free net reclassification improvement afforded by this CatLet score was as follows: 37.2% (p = .008) for MACCEs, 35.5% (p = .0249) for cardiac death, and 31.8% (p = .0316) for all-cause death.
Conclusions:
The ability to integrate the variability in coronary anatomy into angiographic scoring makes the CatLet score a more specific tool for outcome predictions in AMI. (http://www.chictr.org.cn. Unique identifiers: ChiCTR-POC-17013536).
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