No-Reflow Prediction in Acute Coronary Syndrome During Percutaneous Coronary Intervention: The NORPACS Risk Score

Dawson, Luke P.; Rashid, Muhammad; Dinh, Diem T.; Brennan, Angela; Bloom, Jason E.; Biswas, Sinjini; Lefkovits, Jeffrey; Shaw, James A.; Chan, William; Clark, David J.; Oqueli, Ernesto; Hiew, Chin; Freeman, Melanie; Taylor, Andrew J.; Reid, Christopher M.; Ajani, Andrew E.; Kaye, David M.; Mamas, Mamas A.; Stub, Dion; and BCIS Investigators, on behalf of the MIG

Abstract

BACKGROUND:
Suboptimal coronary reperfusion (no reflow) is common in acute coronary syndrome percutaneous coronary intervention (PCI) and is associated with poor outcomes. We aimed to develop and externally validate a clinical risk score for angiographic no reflow for use following angiography and before PCI.
METHODS:
We developed and externally validated a logistic regression model for prediction of no reflow among adult patients undergoing PCI for acute coronary syndrome using data from the Melbourne Interventional Group PCI registry (2005–2020; development cohort) and the British Cardiovascular Interventional Society PCI registry (2006–2020; external validation cohort).
RESULTS:
A total of 30 561 patients (mean age, 64.1 years; 24% women) were included in the Melbourne Interventional Group development cohort and 440 256 patients (mean age, 64.9 years; 27% women) in the British Cardiovascular Interventional Society external validation cohort. The primary outcome (no reflow) occurred in 4.1% (1249 patients) and 9.4% (41 222 patients) of the development and validation cohorts, respectively. From 33 candidate predictor variables, 6 final variables were selected by an adaptive least absolute shrinkage and selection operator regression model for inclusion (cardiogenic shock, ST-segment–elevation myocardial infarction with symptom onset >195 minutes pre-PCI, estimated stent length ≥20 mm, vessel diameter <2.5 mm, pre-PCI Thrombolysis in Myocardial Infarction flow <3, and lesion location). Model discrimination was very good (development C statistic, 0.808; validation C statistic, 0.741) with excellent calibration. Patients with a score of ≥8 points had a 22% and 27% risk of no reflow in the development and validation cohorts, respectively.
CONCLUSIONS:
The no-reflow prediction in acute coronary syndrome risk score is a simple count-based scoring system based on 6 parameters available before PCI to predict the risk of no reflow. This score could be useful in guiding preventative treatment and future trials.

Citation

Dawson, L. P., Rashid, M., Dinh, D. T., Brennan, A., Bloom, J. E., Biswas, S., Lefkovits, J., Shaw, J. A., Chan, W., Clark, D. J., Oqueli, E., Hiew, C., Freeman, M., Taylor, A. J., Reid, C. M., Ajani, A. E., Kaye, D. M., Mamas, M. A., Stub, D., & and BCIS Investigators, O. B. O. T. M. (2024). No-Reflow Prediction in Acute Coronary Syndrome During Percutaneous Coronary Intervention: The NORPACS Risk Score. Circulation: Cardiovascular Interventions, 17(4), https://doi.org/10.1161/circinterventions.123.013738

• Journal Article Type: Article
• Acceptance Date: Jan 31, 2024
• Online Publication Date: Mar 15, 2024
• Publication Date: 2024-04
• Deposit Date: Jul 9, 2024
• Journal: Circulation: Cardiovascular Interventions
• Print ISSN: 1941-7640
• Publisher: American Heart Association
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 4
• DOI: https://doi.org/10.1161/circinterventions.123.013738
• Public URL: https://keele-repository.worktribe.com/output/874077
• Additional Information: Received: 2023-10-18; Accepted: 2024-01-31; Published: 2024-03-15