Prediction of microvascular obstruction by coronary artery angiography score after acute ST-segment elevation myocardial infarction：a single-center retrospective observational study

Background: Some coronary artery angiography scores are associated with no-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). However, quality evidence about the association between coronary artery angiography score and microvascular injury is still needed. Our study aimed to validate the ability of coronary artery angiography score in predicting microvascular obstruction (MVO) detected by cardiac magnetic resonance (CMR) imaging.Methods: From October 2020 to October 2021, 141 consecutive patients with acute STEMI who underwent primary PCI and CMR were reviewed retrospectively. CMR were performed between 3 to 7 days after PCI. Patients were divided into MVO group and non-MVO group based on the CMR results. Two coronary artery angiography scores (SYNTAX score and Gensini score) were used to assess the severity of coronary artery atherosclerotic burden.Results: A total of 122 patients were included (mean age 60.6 ± 12.8 years). MVO occurred in 51 (41.8%) patients. Patients with MVO had higher SYNTAX scores (p < 0.001) and Gensini scores (p < 0.001) than those without MVO. Gensini score (r =0.580, p < 0.001) showed relative stronger correlation with infarction size than SYNTAX score (r =0.521, p < 0.001). The areas under the receiver operator characteristic curves of SYNTAX score and Gensini score for predicting MVO patients were 0.726 and 0.805. In multivariable regression analysis, peak troponin I (odd ratio [OR] = 1.196, p = 0.001), left ventricular ejection fraction (LVEF) (OR = 0.915, p = 0.021) and Gensini score (OR = 17.567, p = 0.016) were identified as independent predictors of MVO.Conclusions: In patients with acute STEMI undergoing primary PCI treatment, Gensini score showed relative stronger correlation with infarction size than SYNTAX score and Gensini score may be an independent predictor of MVO.