CatLet©血管造影评分系统对直接经皮冠状动脉介入治疗术后患者30天心脏死亡率的预测价值。
Predictive Values of the CatLet© Angiographic Scoring System for 30-Day Cardiac Mortality in Patients after Primary Percutaneous Coronary Intervention.
作者信息
Zhang Chenjie, Liang Wenhui, Yu Zongliang, He Yongming
机构信息
Department of Cardiology, The First People's Hospital of Kunshan, 215300 Kunshan, Jiangsu, China.
Department of Cardiology, The First Affiliated Hospital of Soochow University, 215000 Suzhou, Jiangsu, China.
出版信息
Rev Cardiovasc Med. 2025 Mar 17;26(3):28198. doi: 10.31083/RCM28198. eCollection 2025 Mar.
BACKGROUND
The Coronary Artery Tree Description and Lesion Evaluation (CatLet©) angiographic scoring system is a newly developed tool to predict the long-term clinical outcomes for patients with acute myocardial infarction (AMI). This study aimed to evaluate the predictive value of this novel angiographic scoring system for cardiac mortality in AMI patients within 30 days of primary percutaneous coronary intervention (pPCI) in AMI patients.
METHODS
Patients with AMI undergoing pPCI were consecutively enrolled between January 2012 and July 2013. The CatLet© score was calculated for all the lesions in the non-occlusive status and were tertile partitioned into three groups: CatLet-low ≤14 (N = 124), CatLet-mid 14-22 (N = 82), and CatLet-top ≥22 (N = 102). The primary endpoint was cardiac mortality at 30 days after the procedure. Survival curves were generated using the Kaplan-Meier method, and survival rates among the CatLet© score tertiles were compared using the Log-rank test. Furthermore, Cox regression analysis was performed to identify the associations between the predictors and clinical outcomes.
RESULTS
A total of 308 patients were included in the final analysis. The included patients were followed up for 30 days, with 19 (6.17%) cardiac death. Kaplan-Meier curves indicated that the CatLet-top tertile exhibited a significant increase in the risk of cardiac mortality when compared with the low and mid tertiles ( for trend <0.01); the CatLet© score remained an independent predictor of 30-day cardiac mortality in AMI patients after adjusting for clinical variables (HR (95% CI): 6.13 (1.29-29.17); < 0.01). The multivariable analysis demonstrated that a per 1 unit increase in CatLet© score was associated with a 1.04 (1.01-1.06)-fold increased risk of cardiac death. The area under the receiver operating characteristic (ROC) curve (AUC) statistic for the CatLet© score was 0.80 (95% CI, 0.69-0.91), with a good calibration (χ = 12.92; = 0.12).
CONCLUSION
The CatLet© score can be used to predict the short-term cardiac death in AMI patients. A CatLet© score ≥22 or ≥11 myocardial segments involved relative to the total 17 segments (the score divided by 2), including culprit or non-culprit vessels, accounting for 65% (11/17) of left ventricle mass involved, is significantly associated with poor prognosis. The current study has extended the application of the CatLet© score in clinical practice.
CLINICAL TRIAL REGISTRATION
ChiCTR-POC-17013536. Registered 25 November, 2017, https://www.chictr.org.cn/showproj.html?proj=22814.
背景
冠状动脉树描述与病变评估（CatLet©）血管造影评分系统是一种新开发的工具，用于预测急性心肌梗死（AMI）患者的长期临床结局。本研究旨在评估这一新型血管造影评分系统对接受直接经皮冠状动脉介入治疗（pPCI）的AMI患者30天内心脏死亡率的预测价值。
方法
2012年1月至2013年7月连续纳入接受pPCI的AMI患者。计算所有非闭塞性病变的CatLet©评分，并将其分为三个三分位数组：CatLet低分组≤14（N = 124），CatLet中分组14 - 22（N = 82），CatLet高分组≥22（N = 102）。主要终点是术后30天的心脏死亡率。采用Kaplan-Meier法生成生存曲线，并使用对数秩检验比较CatLet©评分三分位数组之间的生存率。此外，进行Cox回归分析以确定预测因素与临床结局之间的关联。
结果
最终分析共纳入308例患者。纳入患者随访30天，有19例（6.17%）发生心脏死亡。Kaplan-Meier曲线表明，与低分组和中分组相比，CatLet高分组的心脏死亡风险显著增加（趋势P<0.01）；在调整临床变量后，CatLet©评分仍是AMI患者30天心脏死亡率的独立预测因素（HR（95%CI）：6.13（1.29 - 29.17）；P<0.01）。多变量分析表明，CatLet©评分每增加1个单位，心脏死亡风险增加1.04（1.01 - 1.06）倍。CatLet©评分的受试者工作特征（ROC）曲线下面积（AUC）统计值为0.80（95%CI，0.69 - 0.91），校准良好（χ² = 12.92；P = 0.12）。
结论
CatLet©评分可用于预测AMI患者的短期心脏死亡。CatLet©评分≥22或相对于总共17个节段（评分除以2）累及≥11个心肌节段，包括罪犯血管或非罪犯血管，占左心室质量累及的65%（11/17），与预后不良显著相关。本研究扩展了CatLet©评分在临床实践中的应用。
临床试验注册
ChiCTR-POC-17013536。于2017年11月25日注册，https://www.chictr.org.cn/showproj.html?proj=22814。
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