학술논문
No-Reflow Prediction in Acute Coronary Syndrome During Percutaneous Coronary Intervention: The NORPACS Risk Score
Document Type
Academic Journal
Author
Dawson, Luke P.; Rashid, Muhammad; Dinh, Diem T.; Brennan, Angela; Bloom, Jason E.; Biswas, Sinjini; Lefkovits, Jeffrey; Shaw, James A.; Chan, William; Clark, David J.; Oqueli, Ernesto; Hiew, Chin; Freeman, Melanie; Taylor, Andrew J.; Reid, Christopher M.; Ajani, Andrew E.; Kaye, David M.; Mamas, Mamas A.; Stub, Dion
Source
Circulation: Cardiovascular Interventions. Apr 01, 2024 17(4):e013738-e013738
Subject
Language
English
ISSN
1941-7632
Abstract
BACKGROUND:: Suboptimal coronary reperfusion (no reflow) is common in acute coronary syndrome percutaneous coronary intervention (PCI) and is associated with poor outcomes. We aimed to develop and externally validate a clinical risk score for angiographic no reflow for use following angiography and before PCI. METHODS:: We developed and externally validated a logistic regression model for prediction of no reflow among adult patients undergoing PCI for acute coronary syndrome using data from the Melbourne Interventional Group PCI registry (2005–2020; development cohort) and the British Cardiovascular Interventional Society PCI registry (2006–2020; external validation cohort). RESULTS:: A total of 30 561 patients (mean age, 64.1 years; 24% women) were included in the Melbourne Interventional Group development cohort and 440 256 patients (mean age, 64.9 years; 27% women) in the British Cardiovascular Interventional Society external validation cohort. The primary outcome (no reflow) occurred in 4.1% (1249 patients) and 9.4% (41 222 patients) of the development and validation cohorts, respectively. From 33 candidate predictor variables, 6 final variables were selected by an adaptive least absolute shrinkage and selection operator regression model for inclusion (cardiogenic shock, ST-segment–elevation myocardial infarction with symptom onset >195 minutes pre-PCI, estimated stent length ≥20 mm, vessel diameter <2.5 mm, pre-PCI Thrombolysis in Myocardial Infarction flow <3, and lesion location). Model discrimination was very good (development C statistic, 0.808; validation C statistic, 0.741) with excellent calibration. Patients with a score of ≥8 points had a 22% and 27% risk of no reflow in the development and validation cohorts, respectively. CONCLUSIONS:: The no-reflow prediction in acute coronary syndrome risk score is a simple count-based scoring system based on 6 parameters available before PCI to predict the risk of no reflow. This score could be useful in guiding preventative treatment and future trials.