Age, Serum Creatinine, and Left Ventricular Ejection Fraction Improved the Performance of the CatLet Angiographic Scoring System in Terms of Outcome Predictions for Patients with Acute Myocardial Infarction: A Median 4.3-Year Follow-Up Study

Abstract

<b><i>Background:</i></b> We recently developed the Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system. Our preliminary study demonstrated that the CatLet score better predicted clinical outcomes than the SYNTAX score. The current study aimed at assessing whether 3 clinical variables (CVs) – age, serum creatinine, and left ventricular ejection fraction (LVEF) – improved the performance of the CatLet score in outcome predictions in patients with acute myocardial infarction (AMI). <b><i>Methods:</i></b> This study was a post hoc study of the CatLet score validation trial. Primary endpoint was major adverse cardiac or cerebrovascular events (MACCEs), and secondary endpoints were all-cause deaths and cardiac deaths. <b><i>Results:</i></b> Over 1,185 person-years (median [interquartile range], 4.3 [3.8–4.9] years), there were 64 MACCEs (20.8%), 56 all-cause deaths (18.2%), and 47 cardiac deaths (15.2%). The addition of the 3 CVs to the stand-alone CatLet score significantly increased the Harrell’s C-index by 0.0967 (<i>p</i> = 0.002) in MACCEs, by 0.1354 (<i>p</i> < 0.001) in all-cause deaths, and by 0.1187 (<i>p</i> = 0.001) in cardiac deaths. When compared with the stand-alone CatLet score, improved discrimination and better calibration led to a significantly refined risk stratification, particularly at the intermediate-risk category. <b><i>Conclusions:</i></b> CatLet score had a predicting value for clinical outcome in AMI patients. This predicting value can be improved through a combination with age, serum creatinine, and LVEF (http://www.chictr.org.cn; unique identifier: ChiCTR-POC-17013536).

The predictive value of CatLet© angiographic scoring system for long-term prognosis in patients with acute myocardial infarction presenting > 12 h after symptom onset

“…Expectedly, patients with higher CatLet score tertiles were older, had higher rates of diabetes, and had lower serum albumin levels and LVEF, which was consistent with our previous studies ( 11 , 12 ). Interestingly, in the current study, current smokers had lower CatLet scores, namely “smoker’s paradox.” A similar phenomenon also appeared in our previous studies and some studies of the SYNTAX score ( 11 , 12 , 14 , 19 ). Possible explanations include the younger age and fewer cardiovascular risk factors in smokers compared with non-smokers ( 20 ).…”

“…Interestingly, in the current study, current smokers had lower CatLet scores, namely "smoker's paradox." A similar phenomenon also appeared in our previous studies and some studies of the SYNTAX score (11,12,14,19). Possible explanations include the younger age and fewer cardiovascular risk factors in smokers compared with non-smokers (20).…”

“…Our prior study showed that the CatLet score better predicted the long-term prognosis among patients who survived AMI presenting at ≤ 12 h and received primary PCI than the SYNTAX score, with a satisfactory inter-or intra-observer reproducibility (11)(12)(13). The current study aimed to validate that the CatLet score remained a useful tool for outcome prediction in patients with AMI presenting > 12 h after symptom onset.…”

“…We have described the CatLet score in detail elsewhere (10)(11)(12). In short, it is a new scoring system that attempts to adequately consider coronary variability and risk-stratify patients with coronary artery disease.…”

“…Further studies are needed to clarify whether the FFR-guided CatLet score is a better predictor of prognosis than the one just based on the visual assessment. Finally, our previous study has shown that the clinically adjusted CatLet score model has a better prognostic value in AMI patients receiving primary PCI ( 12 ). In the current study, we also found that clinical variables can in part explain clinical outcomes.…”