title: Development and validation of a clinical risk score predicting the no-reflow phenomenon in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  The 'no-reflow' phenomenon after a primary percutaneous coronary intervention (pPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) is a strong predictor of both short- and long-term mortality. We therefore developed and prospectively validated a risk score system in order to identify STEMI patients at high risk in terms of no-reflow after primary PCI.
  
  
  METHODS
  The first part of our study used data from 1,615 STEMI patients who underwent primary PCI within 12 h from symptom onset. Using logistic regression, we derived a risk score to predict angiographic no-reflow using baseline clinical variables. From this score, we developed a simplified fast-track screen that can be used before reperfusion. In the second part of our study, we prospectively validated the score system using receiver-operating characteristic (ROC) curves with data from 692 STEMI patients.
  
  
  RESULTS
  The model included six clinical items: age, neutrophil count, admission plasma glucose, β-blocker treatment, time-to-hospital admission and Killip classes. The risk score system demonstrated a good risk prediction with a c-statistic of 0.757 (95% CI 0.732-0.781) based on ROC analysis.
  
  
  CONCLUSIONS
  A simple risk score system based on clinical variables is useful to predict the risk of developing no-reflow after pPCI in patients with STEMI.
authors.affiliation: Department of Cardiology, Chinese PLA General Hospital, 100853 Beijing, PR China.
authors.forename: Jin-Wen
authors.initials: JW
authors.lastname: Wang
authors.forename: Yun-Dai
authors.initials: YD
authors.lastname: Chen
authors.forename: Chang-Hua
authors.initials: CH
authors.lastname: Wang
authors.forename: Xin-Chun
authors.initials: XC
authors.lastname: Yang
authors.forename: Xiao-Ling
authors.initials: XL
authors.lastname: Zhu
authors.forename: Zi-Qiang
authors.initials: ZQ
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods; D054318:No-Reflow Phenomenon / Q000175:diagnosis*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment