Key result
Clinical variables-adjusted residual CatLet score improves MACCE prediction in AMI to AUC 0.83.
Why the study?
It was hypothesized that the residual CatLet score predicts clinical outcomes in AMI patients, and that combining it with age, creatinine, and ejection fraction enhances prediction.
Does the combination of the residual CatLet (rCatLet) score with clinical variables improve outcome prediction compared to the stand-alone rCatLet score in patients with acute myocardial infarction?
Cohort (n=308)
Does the combination of the residual CatLet (rCatLet) score with clinical variables improve outcome prediction compared to the stand-alone rCatLet score in patients with acute myocardial infarction?
Effect estimate: AUC 0.83 (95% CI 0.78-0.89)
Incorporating age, creatinine, and ejection fraction into the angiographic residual CatLet score significantly improves the prediction of major adverse cardiovascular events in patients with acute myocardial infarction.
Enhances MACCE prediction post-AMI when added to residual CatLet score; hypothesis-generating, should not yet change practice.
BACKGROUND: We have recently developed a new Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system. Our preliminary studies have demonstrated its superiority over the the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery (SYNTAX) score with respect to outcome predictions for acute myocardial infarction (AMI) patients. The current study hypothesized that the residual CatLet (rCatLet) score predicts clinical outcomes for AMI patients and that a combination with the three clinical variables (CVs)-age, creatinine, and ejection fraction, will enhance its predicting values. METHODS: The rCatLet score was calculated retrospectively in 308 consecutively enrolled patients with AMI. Primary endpoint, major adverse cardiac or cerebrovascular events (MACCE) including all-cause mortality, non-fatal AMI, transient ischemic attack/stroke, and ischemia-driven repeat revascularization, was stratified according to rCatLet score tertiles: rCatLet_low ≤3, rCatLet_mid 4-11, and rCatLet_top ≥12, respectively. Cross-validation confirmed a reasonably good agreement between the observed and predicted risks. RESULTS: Of 308 patients analyzed, the rates of MACCE, all-cause death, and cardiac death were 20.8%, 18.2%, and 15.3%, respectively. Kaplan-Meier curves for all endpoints showed increasing outcome events with the increasing tertiles of the rCatLet score, with P values <0.001 on trend test. For MACCE, all-cause death, and cardiac death, the area under the curves (AUCs) of the rCatLet score were 0.70 (95% confidence intervals [CI]: 0.63-0.78), 0.69 (95% CI: 0.61-0.77), and 0.71 (95% CI: 0.63-0.79), respectively; the AUCs of the CVs-adjusted rCatLet score models were 0.83 (95% CI: 0.78-0.89), 0.87 (95% CI: 0.82-0.92), and 0.89 (95% CI: 0.84-0.94), respectively. The performance of CVs-adjusted rCatLet score was significantly better than the stand-alone rCatLet score in terms of outcome predictions. CONCLUSION: The rCatLet score has a predicting value for clinical outcomes for AMI patients and the incorporation of the three CVs into the rCatLet score will enhance its predicting ability. TRIAL REGISTRATION: http://www.chictr.org.cn , ChiCTR-POC-17013536.
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Xu et al. (2023) conducted a cohort in acute myocardial infarction (n=308). Clinical variables-adjusted residual CatLet (rCatLet) score vs. Stand-alone rCatLet score was evaluated on Major adverse cardiac or cerebrovascular events (MACCE) including all-cause mortality, non-fatal AMI, transient ischemic attack/stroke, and ischemia-driven repeat revascularization (AUC 0.83, 95% CI 0.78-0.89). The clinical variables-adjusted residual CatLet score significantly improved the prediction of MACCE in patients with acute myocardial infarction compared to the stand-alone score (AUC 0.83 vs 0.70).
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