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

Abstract

BackgroundNo-reflow is associated with a poor prognosis in STEMI patients. There are many factors and mechanisms that contribute to the development of no-reflow, including age, reperfusion time, a high thrombus burden, Killip class, long stent use, ejection fraction 40, and a high Syntax score. In this study, we aimed to evaluate the parameters associated with no-reflow prediction by creating a new scoring system.

MethodsThe study included 515 consecutive STEMI patients who underwent PCI; 632 STEMI patients who had undergone PCI in another center were included in the external validation of the scoring system. The correlations between 1-year major adverse cardiac events and low/high risk score were assessed.

ResultsIn this study, seven independent variables were used to build a risk score for predicting no-reflow. The predictors of no-reflow are age, EF 40, SS 22, stent length 20, thrombus grade 4, Killip class 3, and pain-balloon time 4h. In the derivation group, the optimal threshold score for predicting no-reflow was >10, with a 75% sensitivity and 77.7% specificity (Area under the curve (AUC)=0.809, 95%CI: 0.772-0.842, P<0.001). In the validation group, AUC was 0.793 (95%CI: 0.760-0.824, P<0.001).

ConclusionThis new score, which can be calculated in STEMI patients before PCI and used to predict no-reflow in STEMI patients, may help physicians to estimate the development of no-reflow in the pre-PCI period.