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Canada acute coronary syndrome risk score predicts no-/slow-reflow in ST-elevation myocardial infarction undergoing
Enmin Xie1,2, Qing Li1,3, Zixiang Ye1,3
1Department of Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China.
Insights
The Canada Acute Coronary Syndrome (C-ACS) risk score effectively predicts no-/slow-reflow after primary percutaneous coronary intervention in ST-elevation myocardial infarction patients. This score is a valuable tool, especially for identifying high-risk male patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- No-/slow-reflow phenomenon post-primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) is linked to poor outcomes.
- Early identification of patients at high risk for no-/slow-reflow is crucial for timely intervention.
- The Canada Acute Coronary Syndrome (C-ACS) risk score is a clinical tool used in acute coronary syndromes.
Purpose of the Study:
- To evaluate the predictive capability of the C-ACS risk score for the occurrence of no-/slow-reflow in STEMI patients undergoing primary PCI.
- To assess the C-ACS score's performance in identifying patients likely to experience impaired coronary blood flow after PCI.
- To determine if the C-ACS score can serve as an independent predictor of no-/slow-reflow.
Main Methods:
- A cohort of 834 STEMI patients undergoing primary PCI were enrolled and categorized by C-ACS scores (0, 1, ≥2).
- The C-ACS score was calculated based on age ≥75, heart rate >100 bpm, systolic blood pressure <100 mmHg, and Killip class >1.
- No-/slow-reflow was defined as Thrombolysis in Myocardial Infarction (TIMI) flow grade 0-2 post-PCI; predictive ability was assessed using receiver operating characteristic (ROC) curve analysis.
Main Results:
- The incidence of no-/slow-reflow increased significantly with higher C-ACS scores (6.1% vs. 17.7% vs. 34.3%, p < 0.001).
- The C-ACS score independently predicted no-/slow-reflow (OR 2.623, p < 0.001) with good discrimination (AUC 0.707, p < 0.001).
- The association was significant in males (OR 3.061, p < 0.001) but not in females, indicating a sex interaction (p=0.011). The C-ACS score also predicted MACE during follow-up.
Conclusions:
- The C-ACS risk score is an independent predictor of no-/slow-reflow in STEMI patients undergoing primary PCI.
- The predictive value of the C-ACS score is particularly pronounced in male patients.
- The C-ACS score demonstrates utility in risk stratification for adverse outcomes following primary PCI in STEMI.
Background:
The no-/slow-reflow phenomenon following primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI)is associated with poor prognosis. The early identification of high-risk patients with no-/slow-reflow is critical. This study aimed to evaluate the predictive ability of the Canada Acute Coronary Syndrome (C-ACS) risk score for no-/slow-reflow in these patients.
Methods:
Patients with STEMI who underwent primary PCI were consecutively enrolled and divided into three groups based on their C-ACS scores: 0, 1, and ≥2. The C-ACS score was computed using the four clinical variables evaluated at admission (one point for each): age ≥75 years, heart rate >100 beats/min, systolic blood pressure <100 mmHg, and Killip class >1. No-/slow-reflow was defined as thrombolysis in a myocardial infarction flow grade of 0-2 after primary PCI. The predictive ability of the C-ACS score for no-/slow-reflow was evaluated using a receiver operating characteristic curve.
Results:
A total of 834 patients were enrolled, of whom 109 (13.1 %) developed no-/slow-reflow. The incidence of no-/slow-reflow increased from the C-ACS 0 group to the C-ACS ≥2 group (6.1 % vs 17.7 % vs 34.3 %, respectively, p < 0.001). After multivariable adjustment, the C-ACS score was an independent predictor of no-/slow-reflow (odd ratio 2.623, 95 % confidence interval 1.948-3.532, p < 0.001). Furthermore, the C-ACS score showed good discrimination for no-/slow-reflow (area under the curve 0.707, 95 % confidence interval 0.653-0.762, p < 0.001). Further subgroup analyses indicated a significant interaction between the C-ACS score and patient sex (p for interaction = 0.011). The independent association between the C-ACS score and no-/slow-reflow was only observed in male patients (odd ratio 3.061, 95 % confidence interval 1.931-4.852, p < 0.001). During a median follow-up duration of 4.3 years, the C-ACS score was independently associated with major adverse cardiovascular events independent of the occurrence of no-/slow-reflow (p for interaction = 0.212).
Conclusion:
The C-ACS risk score could independently predict the no-/slow-reflow in patients with STEMI undergoing primary PCI, particularly in male patients.
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