No-Reflow Prediction in Acute Coronary Syndrome During Percutaneous Coronary Intervention: The NORPACS Risk Score-Reference-Cited by-同舟云学术

No-Reflow Prediction in Acute Coronary Syndrome During Percutaneous Coronary Intervention: The NORPACS Risk Score

Published:2024-04 Issue:4 Volume:17 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Dawson Luke P.¹²³^ORCID,Rashid Muhammad⁴⁵⁶^ORCID,Dinh Diem T.¹^ORCID,Brennan Angela¹^ORCID,Bloom Jason E.²³^ORCID,Biswas Sinjini¹,Lefkovits Jeffrey¹⁷^ORCID,Shaw James A.²³,Chan William¹⁸^ORCID,Clark David J.⁹,Oqueli Ernesto¹⁰¹¹^ORCID,Hiew Chin¹²,Freeman Melanie¹³,Taylor Andrew J.²^ORCID,Reid Christopher M.¹¹⁴^ORCID,Ajani Andrew E.¹⁴⁵⁶,Kaye David M.²³^ORCID,Mamas Mamas A.⁴^ORCID,Stub Dion¹²³^ORCID,

Affiliation:

1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., D.T.D., A.B., S.B., J.L., W.C., C.M.R., A.E.A., D.S.).

2. Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., A.J.T., D.M.K., D.S.).

3. The Baker Institute, Melbourne, Victoria, Australia (L.P.D., J.E.B., J.A.S., D.M.K., D.S.).

4. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stroke on Trent, United Kingdom (M.R., A.E.A., M.A.M.).

5. Department of Cardiovascular Sciences, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, United Kingdom (M.R., A.E.A.).

6. University Hospitals of Leicester National Health Service (NHS) Trust, United Kingdom (M.R., A.E.A.).

7. Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia (J.L.).

8. Department of Medicine, Melbourne University, Victoria, Australia (W.C.).

9. Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (D.J.C.).

10. Department of Cardiology, Grampians Health Ballarat, Victoria, Australia (E.O.).

11. School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia (E.O.).

12. Department of Cardiology, University Hospital Geelong, Victoria, Australia (C.H.).

13. Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia (M.F.).

14. Centre of Clinical Research and Education, School of Public Health, Curtin University, Perth, Western Australia, Australia (C.M.R.).

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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