Xie Enmin, Li Qing, Ye Zixiang, Guo Ziyu, Li Yike, Shen Nan, Yu Changan, Gao Yanxiang, Zheng Jingang
Department of Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China.
China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China.
Heliyon. 2023 Oct 20;9(11):e21276. doi: 10.1016/j.heliyon.2023.e21276. eCollection 2023 Nov.
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.
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.
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, < 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, < 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, < 0.001). Further subgroup analyses indicated a significant interaction between the C-ACS score and patient sex ( 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, < 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 ( for interaction = 0.212).
The C-ACS risk score could independently predict the no-/slow-reflow in patients with STEMI undergoing primary PCI, particularly in male patients.
ST段抬高型心肌梗死（STEMI）患者在接受直接经皮冠状动脉介入治疗（PCI）后出现的无复流/慢复流现象与预后不良相关。早期识别无复流/慢复流的高危患者至关重要。本研究旨在评估加拿大急性冠状动脉综合征（C-ACS）风险评分对这些患者无复流/慢复流的预测能力。
连续纳入接受直接PCI的STEMI患者，并根据其C-ACS评分分为三组：0分、1分和≥2分。C-ACS评分使用入院时评估的四个临床变量计算（每个变量1分）：年龄≥75岁、心率>100次/分钟、收缩压<100 mmHg和Killip分级>1级。无复流/慢复流定义为直接PCI后心肌梗死溶栓分级为0-2级。使用受试者工作特征曲线评估C-ACS评分对无复流/慢复流的预测能力。
共纳入834例患者，其中109例（13.1%）出现无复流/慢复流。无复流/慢复流的发生率从C-ACS 0分组到C-ACS≥2分组逐渐增加（分别为6.1%、17.7%和34.3%，P<0.001）。多变量调整后，C-ACS评分是无复流/慢复流的独立预测因素（比值比2.623，95%置信区间1.948-3.532，P<0.001）。此外，C-ACS评分对无复流/慢复流具有良好的区分度（曲线下面积0.707，95%置信区间0.653-0.762，P<0.001）。进一步的亚组分析表明C-ACS评分与患者性别之间存在显著交互作用（交互作用P=0.011）。C-ACS评分与无复流/慢复流之间的独立关联仅在男性患者中观察到（比值比3.061，95%置信区间1.931-4.852，P<0.001）。在中位随访期4.3年期间，C-ACS评分与主要不良心血管事件独立相关，与无复流/慢复流的发生无关（交互作用P=0.212）。
C-ACS风险评分可独立预测接受直接PCI的STEMI患者的无复流/慢复流，尤其是男性患者。
