Clinical risk scores predict procedural complications of primary percutaneous coronary intervention.
OBJECTIVE
The predictive value of five risk score models containing clinical (PAMI-PMS, GRACE-GRS, and modified ACEF-ACEFm-scores), 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 1.56-6.54, p<0.01 and OR 2.87, 95% CI 1.27-6.45, p=0.01, respectively) and no-reflow (OR 1.71, 95% CI 1.04-2.82, p=0.03 and OR 1.86, 95% CI 1.10-3.14, p=0.01, respectively).


CONCLUSIONS
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.
Department of Internal Medicine, University of Medicine and Pharmacy of Tîrgu Mureş; Department of Interventional Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation; Tîrgu Mureş-Romania. hadadilaci@yahoo.com.
László
L
Hadadi
Razvan Constantin
RC
Şerban
Alina
A
Scridon
Ioana
I
Şuş
Éva Katalin
ÉK
Lakatos
Zoltán
Z
Demjén
Dan
D
Dobreanu
D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000601:surgery*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index