The ATI score accurately predicted post-stenting microvascular impairment (IMR >40) in STEMI patients undergoing primary percutaneous coronary intervention, with an AUC of 0.87.
Cohort (n=186)
Yes
Does the ATI score predict post-procedural microvascular impairment (IMR >40) in STEMI patients undergoing PPCI?
The ATI score is a simple, procedurally derived tool that accurately predicts the risk of post-stenting microvascular impairment in STEMI patients, allowing for early risk stratification during PPCI.
Effect estimate: AUC 0.87 (95% CI 0.82-0.92)
p-value: p=<0.001
AIMS: Restoration of effective myocardial reperfusion by primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction is difficult to predict. A method to assess the likelihood of a suboptimal response to conventional pharmacomechanical 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. METHODS AND RESULTS: 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 40 in all four cohorts (AUC: 0.87; p40, while no cases of final IMR >40 occurred in the presence of an ATI score <2. CONCLUSIONS: The ATI score appears to be a promising tool capable of identifying patients during PPCI who are at the highest risk of coronary microvascular impairment following revascularisation. This procedural risk stratification has a number of potential research and clinical applications and warrants further investigation.
Maria et al. (Tue,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=186). ATI score (Age, Thrombus score, pre-stenting IMR) was evaluated on Prediction of post-stenting index of microcirculatory resistance (IMR) >40 (AUC 0.87, 95% CI 0.82-0.92, p=<0.001). The ATI score accurately predicted post-stenting microvascular impairment (IMR >40) in STEMI patients undergoing primary percutaneous coronary intervention, with an AUC of 0.87.