Bayramoğlu Adil, Taşolar Hakan, Kaya Ahmet, Tanboğa İbrahim Halil, Yaman Mehmet, Bektaş Osman, Günaydın Zeki Yüksel, Oduncu Vecih
Department of Cardiology, Faculty of Medicine, Ordu University, Ordu, Turkey.
Department of Cardiology, Adiyaman University Training and Research Hospital, Adıyaman, Turkey.
J Interv Cardiol. 2018 Apr;31(2):144-149. doi: 10.1111/joic.12463. Epub 2017 Nov 28.
No-reflow is associated with a poor prognosis in STEMI patients. There are many factors and mechanisms that contribute to the development of no-reflow, including age, reperfusion time, a high thrombus burden, Killip class, long stent use, ejection fraction ≤40, and a high Syntax score. In this study, we aimed to evaluate the parameters associated with no-reflow prediction by creating a new scoring system.
The study included 515 consecutive STEMI patients who underwent PCI; 632 STEMI patients who had undergone PCI in another center were included in the external validation of the scoring system. The correlations between 1-year major adverse cardiac events and low/high risk score were assessed.
In this study, seven independent variables were used to build a risk score for predicting no-reflow. The predictors of no-reflow are age, EF ≤40, SS ≥22, stent length ≥20, thrombus grade ≥4, Killip class ≥3, and pain-balloon time ≥4 h. In the derivation group, the optimal threshold score for predicting no-reflow was >10, with a 75% sensitivity and 77.7% specificity (Area under the curve (AUC) = 0.809, 95%CI: 0.772-0.842, P < 0.001). In the validation group, AUC was 0.793 (95%CI: 0.760-0.824, P < 0.001).
This new score, which can be calculated in STEMI patients before PCI and used to predict no-reflow in STEMI patients, may help physicians to estimate the development of no-reflow in the pre-PCI period.
无复流现象与ST段抬高型心肌梗死（STEMI）患者的不良预后相关。促成无复流现象发生的因素和机制众多，包括年龄、再灌注时间、高血栓负荷、Killip分级、长支架使用、射血分数≤40以及高Syntax评分。在本研究中，我们旨在通过创建一种新的评分系统来评估与无复流预测相关的参数。
本研究纳入了515例连续接受经皮冠状动脉介入治疗（PCI）的STEMI患者；632例在另一个中心接受过PCI的STEMI患者被纳入评分系统的外部验证。评估了1年主要不良心脏事件与低/高风险评分之间的相关性。
在本研究中，使用七个独立变量构建了预测无复流的风险评分。无复流的预测因素为年龄、射血分数≤40、Syntax评分≥22、支架长度≥20、血栓分级≥4、Killip分级≥3以及疼痛至球囊扩张时间≥4小时。在推导组中，预测无复流的最佳阈值评分为>10，敏感性为75%，特异性为77.7%（曲线下面积（AUC）=0.809，95%置信区间：0.772 - 0.842，P<0.001）。在验证组中，AUC为0.793（95%置信区间：0.760 - 0.824，P<0.001）。
这种新的评分可在STEMI患者PCI术前计算得出，并用于预测STEMI患者的无复流现象，可能有助于医生在PCI术前评估无复流现象的发生情况。
