Author + information
- S193687981502052X-076583726d5d894b7bd760d04c1749b0Giovanni Luigi De Maria1,
- S193687981502052X-fe3f135bc51102bbd6c1449c37056849Gregor Fahrni1,
- S193687981502052X-1715f6dc72f96b35d82f78405ebd97ceMohammad Alkhalil1,
- S193687981502052X-08b280ff2bbe4c8b1f3df9982dba7f45Florim Cuculi1,
- S193687981502052X-593431774397c88efe77b142406a8766Sam Dawkins1,
- S193687981502052X-ac4bcf2e27f26de85554caad73895426Mathias Wolfrum1,
- S193687981502052X-6e272726736092d3096fbdb1822e07b9Robin Chouhury1,
- S193687981502052X-5b11d62d77ea379d923bed80fb42e301Colin Forfar1,
- S193687981502052X-8da5ba1032cf65e6ed92d3c961720b9cBernard Prendergast1,
- S193687981502052X-6e4a829e523032c722e9a1b655b275bdTuncay Yetgin2,
- S193687981502052X-dfdab769c44b4d28f05c29a3d8aef140Robert van Geuns3,
- S193687981502052X-1fb8f5ecc38b5bdc8e76997bc3505b08Matteo Tebaldi4,
- S193687981502052X-4a1e833a189ba9d303b91e5a47509658Keith Channon1,
- S193687981502052X-93275bbb7b376c1cc7f69b96f1cdab5dRajesh Kharbanda1,
- S193687981502052X-0e287c657ea5013049d25110fa5f96c1Peter Rothwell1,
- S193687981502052X-8169b8b1e262554a8461953160995adaMarco Valgimigli5 and
- S193687981502052X-26176d38119bb221780c53c1e9541e19Adrian Banning1
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.
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.
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 revascularization.