Clinical risk scores predict procedural complications of primary percutaneous coronary intervention
Laszlo Hadadi1, Razvan Constantin Ŝerban2, Alina Scridon3, Ioana Ŝuŝ4, Eva Katalin Lakatos5, Zoltan Demjen6, Dan Dobreanu41Departments of Internal Medicine, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania, Departments of Interventional Cardiology Emergency Institute for Cardiovascular Diseases and Transplantation; Tirgu Mureŝ-Romania2Departments of Interventional Cardiology Emergency Institute for Cardiovascular Diseases and Transplantation; Tirgu Mureŝ-Romania, Physiology, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania
3Physiology, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania
4Physiology, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania, Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation; Tirgu Mureŝ-Romania
5Departments of Internal Medicine, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania
6Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation; Tirgu Mureŝ-Romania
Objective: The predictive value of five risk score models containing clinical (PAMI-PMS, GRACEGRS, and modified ACEF-ACEFmscores), angiographic SYNTAX score (SXS) and combined Clinical SYNTAX score (CSS) variables were evaluated for the incidence of three procedural complications of primary percutaneous coronary intervention (pPCI): iatrogenic coronary artery dissection, angiographically visible distal embolization and angiographic no-reflow phenomenon.
Methods: The mentioned scores and the incidence of procedural complications were retrospectively analyzed in 399 consecutive patients with acute ST-elevation myocardial infarction who underwent pPCI.
Results: Coronary dissection, distal embolization and no-reflow occurred in 39 (9.77%), 71 (17.79%), and 108 (27.07%) subjects, respectively. Coronary dissections were significantly associated with higher GRS, ACEFm, and CSS values (all p<0.05). PMS, GRS, ACEFm, and CSS were significantly higher in patients with no-reflow (all p<0.05), while distal embolization was not predicted by any of the calculated scores. In multiple logistic regression models, GRS and ACEFm remained independent predictors of both coronary dissections (OR 3.20, 95% CI 1.566.54, p<0.01 and OR 2.87, 95% CI 1.276.45, p=0.01, respectively) and no-reflow (OR 1.71, 95% CI 1.042.82, p=0.03 and OR 1.86, 95% CI 1.103.14, p=0.01, respectively).
Conclusion: Whereas SXS failed to predict procedural complications related to pPCI, two simple, noninvasive risk models, GRS and ACEFm, independently predicted coronary dissections and no-reflow. Pre-interventional assessment of these scores may help the interventional cardiologist to prepare for procedural complications during pPCI.
Clinical risk scores predict procedural complications of primary percutaneous coronary intervention
Laszlo Hadadi1, Razvan Constantin Ŝerban2, Alina Scridon3, Ioana Ŝuŝ4, Eva Katalin Lakatos5, Zoltan Demjen6, Dan Dobreanu41Departments of Internal Medicine, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania, Departments of Interventional Cardiology Emergency Institute for Cardiovascular Diseases and Transplantation; Tirgu Mureŝ-Romania2Departments of Interventional Cardiology Emergency Institute for Cardiovascular Diseases and Transplantation; Tirgu Mureŝ-Romania, Physiology, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania
3Physiology, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania
4Physiology, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania, Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation; Tirgu Mureŝ-Romania
5Departments of Internal Medicine, University of Medicine and Pharmacy of Tirgu Mureŝ; Tirgu Mureŝ-Romania
6Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation; Tirgu Mureŝ-Romania
Objective: The predictive value of five risk score models containing clinical (PAMI-PMS, GRACEGRS, and modified ACEF-ACEFmscores), angiographic SYNTAX score (SXS) and combined Clinical SYNTAX score (CSS) variables were evaluated for the incidence of three procedural complications of primary percutaneous coronary intervention (pPCI): iatrogenic coronary artery dissection, angiographically visible distal embolization and angiographic no-reflow phenomenon.
Methods: The mentioned scores and the incidence of procedural complications were retrospectively analyzed in 399 consecutive patients with acute ST-elevation myocardial infarction who underwent pPCI.
Results: Coronary dissection, distal embolization and no-reflow occurred in 39 (9.77%), 71 (17.79%), and 108 (27.07%) subjects, respectively. Coronary dissections were significantly associated with higher GRS, ACEFm, and CSS values (all p<0.05). PMS, GRS, ACEFm, and CSS were significantly higher in patients with no-reflow (all p<0.05), while distal embolization was not predicted by any of the calculated scores. In multiple logistic regression models, GRS and ACEFm remained independent predictors of both coronary dissections (OR 3.20, 95% CI 1.566.54, p<0.01 and OR 2.87, 95% CI 1.276.45, p=0.01, respectively) and no-reflow (OR 1.71, 95% CI 1.042.82, p=0.03 and OR 1.86, 95% CI 1.103.14, p=0.01, respectively).
Conclusion: Whereas SXS failed to predict procedural complications related to pPCI, two simple, noninvasive risk models, GRS and ACEFm, independently predicted coronary dissections and no-reflow. Pre-interventional assessment of these scores may help the interventional cardiologist to prepare for procedural complications during pPCI.
Corresponding Author: Laszlo Hadadi, Romania
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