title: Development and Validation of a Distal Embolization Risk Score During Primary Angioplasty in ST-Elevation Myocardial Infarction.
abstract: This study aims to develop and validate a new angiographic risk score to predict the risk of distal embolization (DE) during primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction. Study included data from 1,200 patients who underwent p-PCI. The cohort was randomly split into a derivation cohort (n = 814) and a validation cohort (n = 386). Logistic regression was used to examine the relation between risk factors and the occurrence of DE. To each covariate in the model was assigned an integer score based on the regression coefficients. Variables included in the risk score, according to multivariable analysis, were occlusion pattern of infarct-related artery, Thrombolysis In Myocardial Infarction Thrombus Score 2 to 4, reference vessel diameter ≥3.5 mm, and lesion length >20 mm. To each variable was assigned a 0- to +2-point score according to the strength of the statistical association. Rates of DE in low-, intermediate-, and high-risk groups were 5.6%, 15.8%, and 40% in the derivation cohort (p for trend <0.0001; C-statistic 0.70) and 7.5%, 12.1%, and 37.9% in the validation cohort (p for trend <0.0001; C-statistic 0.62), respectively. In conclusion, the individual risk of DE in patients who underwent p-PCI can be predicted using a simple 4-variables model based on angiographic features.
authors.affiliation: Cardiology Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy. Electronic address: massimo.napodano@gmail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.affiliation: Cardiology Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Al Mamary
authors.affiliation: Cardiology Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Zilio
authors.affiliation: Cardiology Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Dariol
authors.affiliation: Biostatistics Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Cardiology Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Cardiology Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Carrer
authors.affiliation: Cardiology Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fraccaro
authors.affiliation: Cardiology Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: D'Amico
authors.affiliation: Cardiology Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography; D004562:Electrocardiography; D004617:Embolism / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011897:Random Allocation; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015607:Stents