RT Journal Article
SR Electronic
T1 11 Predicting the outcome of reperfusion acutely in patients with STEMI – derivation and validation of the ATI score
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP A6
OP A6
DO 10.1136/heartjnl-2016-309588.11
VO 102
IS Suppl 4
A1 Giovanni Luigi De Maria
A1 Gregor Fahrni
A1 Mohammad Alkhalil
A1 Florim Cuculi
A1 Sam Dawkins
A1 Mathias Wolfrum
A1 Robin P Choudhury
A1 John C Forfar
A1 Bernard D Prendergast
A1 Tuncay Yetgin
A1 Robert Jan van Geuns
A1 Matteo Tebaldi
A1 Keith M Channon
A1 Rajesh K Kharbanda
A1 Peter M Rothwell
A1 Marco Valgimigli
A1 Adrian P Banning
YR 2016
UL http://heart.bmj.com/content/102/Suppl_4/A6.2.abstract
AB Aim Restoration of effective myocardial reperfusion by primary percutaneous coronary intervention (PPCI) in patients with STEMI is not predictable. A method to assess the likelihood of a suboptimal response to conventional pharmaco-mechanical therapies could be beneficial. We aimed to derive and validate a scoring system that can be used acutely at the time of coronary reopening to predict the likelihood of downstream microvascular impairment in patients with STEMI.Methods and Results A score estimating the risk of post-procedural microvascular injury defined by an index of microcirculatory resistance (IMR) > 40, was initially derived in a cohort of 85 STEMI patients (Derivation cohort). This score was then tested and validated in three further cohorts of patients (Retrospective (30 patients), Prospective (42 patients) and External (29 patients).The ATI score [Age ( > 50 = 1); pre-stenting IMR (> 40 and < 100 = 1; ≥ 100 = 2); Thrombus score (4=1; 5=3)] was highly predictive of a post-stenting IMR > 40 in all the four cohorts (AUC:0.87; p < 0.001-Derivation cohort, 0.84; p: 0.002-Retrospective cohort, 0.92; p < 0.001-Prospective cohort and 0.81; p: 0.006-External cohort). In the whole population an ATI score ≥ 4 presented a 95.1% risk of final IMR >40, while no cases of final IMR >40 occurred in the presence of an ATI score < 2.Conclusions The ATI score appears to be a promising tool capable of identifying patients during PPCI that are at the highest risk of an adverse outcome following revascularisation.