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.).
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.).
Circ Cardiovasc Interv. 2024 Apr;17(4):e013738. doi: 10.1161/CIRCINTERVENTIONS.123.013738. Epub 2024 Mar 15.
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.
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).
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.
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.
急性冠状动脉综合征经皮冠状动脉介入治疗（PCI）中经常出现不完全的冠状动脉再灌注（无再流），并且与不良预后相关。我们旨在开发并验证一种用于 PCI 前的急性冠状动脉综合征患者的血管造影无再流的临床风险评分。
我们使用墨尔本介入治疗组 PCI 登记处（2005-2020 年；开发队列）和英国心血管介入治疗学会 PCI 登记处（2006-2020 年；外部验证队列）的数据，开发并验证了一种用于预测接受 PCI 治疗的急性冠状动脉综合征患者无再流的逻辑回归模型。
共纳入 30561 例墨尔本介入治疗组开发队列患者（平均年龄 64.1 岁，24%为女性）和 440256 例英国心血管介入治疗学会外部验证队列患者（平均年龄 64.9 岁，27%为女性）。主要结局（无再流）分别发生在开发队列和验证队列的 4.1%（1249 例）和 9.4%（41222 例）患者中。通过自适应最小绝对收缩和选择算子回归模型，从 33 个候选预测变量中选择了 6 个最终变量进行纳入（心源性休克、PCI 前症状发作 >195 分钟的 ST 段抬高型心肌梗死、预估支架长度≥20mm、血管直径<2.5mm、PCI 前血栓溶解心肌梗死血流<3、病变部位）。模型的区分度非常好（开发队列 C 统计量为 0.808，验证队列 C 统计量为 0.741），且校准度良好。在开发和验证队列中，评分≥8 分的患者无再流的风险分别为 22%和 27%。
急性冠状动脉综合征风险评分中的无再流预测是一种简单的基于 6 个参数的计数评分系统，这些参数在 PCI 前即可获得，可用于预测无再流的风险。该评分可能有助于指导预防性治疗和未来的试验。
