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Gensini Score and Thrombus Burden Add Predictive Value to the SYNTAX Score in Detecting No-Reflow after Myocardial

Luís Carlos V Matos1,2, Luiz Sergio Carvalho3,2, Rodrigo Modolo3

  • 1Escola Superior de Ciências da Saúde,Brasília, DF - Brasil.

Arquivos Brasileiros De Cardiologia
|March 3, 2021
PubMed

Insights

Predicting no-reflow in ST-segment elevation myocardial infarction (STEMI) is improved by combining the SYNTAX score with atherosclerotic and thrombus burden. This enhanced prediction aids in managing patients undergoing percutaneous coronary intervention.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • No-reflow phenomenon after percutaneous coronary intervention (PCI) is linked to poor prognosis in ST-segment elevation myocardial infarction (STEMI) patients.
  • The SYNTAX score is recognized as a predictor of no-reflow, but its predictive accuracy may be enhanced.

Purpose of the Study:

  • To assess if atherosclerotic burden (Gensini score) and thrombus burden improve the SYNTAX score's ability to predict no-reflow in STEMI patients.
  • To evaluate the combined predictive value of these factors for no-reflow.

Main Methods:

  • Prospective cohort study including 481 STEMI patients presenting within 12 hours of symptom onset.
  • No-reflow defined as TIMI flow < 3 or TIMI flow = 3 with myocardial blush grade < 2.
  • Thrombus burden quantified using the TIMI thrombus grade scale (0-5); Gensini score assessed atherosclerotic burden.

Main Results:

  • No-reflow occurred in 32.8% of patients.
  • SYNTAX score, thrombus burden, and Gensini score were independent predictors of no-reflow (p<0.01 for all).
  • The combined score model showed a significantly larger area under the curve (0.78 vs. 0.73, p=0.03) and improved predictive ability (Net Reclassification Improvement > 0, p<0.001).

Conclusions:

  • Atherosclerotic burden and thrombus burden in the culprit artery enhance the predictive value of the SYNTAX score for the no-reflow phenomenon in STEMI patients undergoing PCI.
  • The combined assessment offers a more accurate prediction of no-reflow compared to the SYNTAX score alone.
  • These findings support incorporating assessments of atherosclerotic and thrombus burden for better no-reflow prediction in STEMI management.
Abstract

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