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Prediction of type 4a myocardial infarction with the angiography-derived hemodynamic (ADDED) index
Fabio Mangiacapra1, Raffaele Rinaldi2, Iginio Colaiori2
1Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy. f.mangiacapra@unicampus.it.
Insights
The angiography-derived hemodynamic index (ADDED) effectively predicts type 4a myocardial infarction (MI) after percutaneous coronary intervention (PCI). Higher ADDED index values indicate a greater risk of this complication in patients with chronic coronary syndrome.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Type 4a myocardial infarction (MI) is a significant complication of percutaneous coronary intervention (PCI), associated with increased mortality.
- Predicting type 4a MI is crucial for patient management and risk stratification during PCI procedures.
Purpose of the Study:
- To evaluate the angiography-derived hemodynamic index (ADDED) as a predictor of type 4a MI in patients with chronic coronary syndrome (CCS) undergoing PCI.
- To assess the correlation between the ADDED index and the incidence of type 4a MI.
Main Methods:
- A study involving 442 patients undergoing single-vessel PCI for CCS.
- The ADDED index was calculated using quantitative angiography, defined as the ratio of the Duke Jeopardy Score to the minimum lumen diameter.
- Patients were stratified into tertiles based on their ADDED index values.
Main Results:
- The incidence of type 4a MI increased significantly across ADDED index tertiles (3.3% in low, 5.5% in mid, 17.7% in high; p < 0.0001).
- The ADDED index demonstrated significant discriminatory power for type 4a MI (Area Under Curve = 0.745).
- An ADDED index value > 5.25 was identified as the strongest independent predictor of type 4a MI.
Conclusions:
- The ADDED index serves as a valuable predictor of type 4a MI in patients with CCS undergoing elective single-vessel PCI.
- Further research is warranted to investigate whether targeted preventive strategies for high-ADDED index patients can improve outcomes.
Abstract:
Percutaneous coronary intervention (PCI) is frequently complicated by type 4a myocardial infarction (MI), which is associated with an increased risk of mortality. We assessed the usefulness of the angiography-derived hemodynamic index (ADDED), which is based on the extent of myocardium at risk and on the anatomical lesion severity, in predicting type 4a MI in patients with chronic coronary syndrome (CCS) undergoing PCI. We enrolled 442 patients treated with single-vessel PCI. The ADDED index was calculated as the ratio of the Duke Jeopardy Score to the minimum lumen diameter assessed with quantitative angiography analysis. Type 4a MI was defined according to the 4th Universal Definition of MI. The overall population was divided into tertiles of ADDED index. Type 4a MI occurred in 5 patients (3.3%) in the ADDED-low tertile, 8 (5.5%) in the ADDED-mid tertile, and 26 (17.7%) in the ADDED-high tertile (p < 0.0001). At ROC curve analysis, the ADDED index could significantly discriminate between patients with and without type 4a MI (area under the curve 0.745). At multivariate analysis, an ADDED index value > 5.25 was the strongest independent predictor type 4a MI. Our results support the role of the ADDED index as a predictor of type 4a MI in patients with CCS treated with elective PCI of a single vessel. Whether a selective use of additional preventive measures in patients considered at high risk based on ADDED index values may improve peri-procedural and long-term outcomes remains to be tested in dedicated investigations.
