A Risk Score for No Reflow in Patients With ST‐Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

Abstract

Background: Many factors are associated with no-reflow (NRF) phenomenon in ST-segment elevation myocardial infarction (STEMI), including plasma glucose, age, and pre-percutaneous coronary intervention (PCI) thrombus score. Initial clinical assessment would benefit from accurate NRF prediction. This study aimed to develop a simple scoring system to predict the risk of NRF in patients undergoing primary PCI with STEMI. Methods: Baseline clinical and procedural variables were used for risk score development (the training dataset, n = 912) and validation (the test dataset, n = 864). Independent predictors of NRF from the multivariable model were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver operating characteristic analysis using the test dataset.Results: The final model included 7 significant variables, which were age, pain-to-PCI time, neutrophil count, admission plasma glucose level, pre-PCI thrombus score, collateral circulation, and Killip class. All these variables were then used to build a risk score in terms of the prediction of NRF. Receiver operating characteristic analysis demonstrated good risk prediction with a c statistic of 0.800 (95% confidence interval: 0.772-0.826) in the test dataset. Conclusions: In patients with STEMI treated by primary PCI, incidence of NRF phenomenon may be predicted with an acceptable accuracy based on a 7-item simplified risk score.

Prediction of no‐reflow and major adverse cardiovascular events with a new scoring system in STEMI patients

“…In their study, Yesin et al showed that SS II could predict no‐reflow . Wang et al also predicted no‐reflow in the model they developed …”

“…In the above‐mentioned studies, the incorporation of laboratory parameters into the scores might be helpful for implementing post‐procedural measures. However, these parameters do not enable the calculation of a risk score before the procedure . Unlike the previous scoring systems, we believe that the use of demographic and angiographic parameters that could be evaluated faster enable a more rapid evaluation independent of laboratory parameters, and thus this score would be helpful before PCI.…”

“…The development of no‐reflow is multifactorial, and the etiology is not fully understood . Although age ≥65 years, reperfusion time >4 h, a high thrombus burden, Killip class ≥3, long stent use, ejection fraction ≤40 and a high syntax score (SS) have been shown as predictors, new scales may guide interventions prior to a procedure when no‐reflow is likely to develop …”

“…6 Although age ≥65 years, reperfusion time >4 h, a high thrombus burden, Killip class ≥3, long stent use, ejection fraction ≤40 and a high syntax score (SS) have been shown as predictors, new scales may guide interventions prior to a procedure when no-reflow is likely to develop. [7][8] In this study, we aimed to evaluate the parameters associated with no-reflow in previous studies in terms of no-reflow and MACE prediction by creating a new scoring system.…”

Association of monocyte count on admission with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

“…A two-sided p value < 0.05 was considered significant. Potential independent variables associated with no-reflow in previous studies [7,8] or significantly different between the no-reflow and normal reflow groups in our study were selected for univariate analysis. All the significant variables from the univariate analysis were entered into the multivariate logistic regression model to identify independent predictors for the development of the no-reflow phenomenon.…”