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Comparação entre Dois Escores de Risco quanto à Predição de Obstrução Microvascular Coronariana durante a Intervenção Percutânea Primária / The Comparison between Two Risk Scores as for the Prediction of Coronary Microvascular Obstruction during Primary Percutaneous Intervention
Xiao, Yuyang; Chen, Hua; Liu, Dongxia; Wang, Yanbo; Wang, Wenlu; Zhang, Qian; Han, Yuping; Fu, Xianghua.
  • Xiao, Yuyang; Hebei General Hospital. Department of Cardiology. Shijiazhuang. CN
  • Chen, Hua; Hebei General Hospital. Department of Cardiology. Shijiazhuang. CN
  • Liu, Dongxia; Hebei General Hospital. Department of Cardiology. Shijiazhuang. CN
  • Wang, Yanbo; Second Hospital of Hebei Medical University. Department of Cardiology. Shijiazhuang. CN
  • Wang, Wenlu; Second Hospital of Hebei Medical University. Department of Cardiology. Shijiazhuang. CN
  • Zhang, Qian; Second Hospital of Hebei Medical University. Department of Cardiology. Shijiazhuang. CN
  • Han, Yuping; Hebei General Hospital. Department of Cardiology. Shijiazhuang. CN
  • Fu, Xianghua; Second Hospital of Hebei Medical University. Department of Cardiology. Shijiazhuang. CN
Arq. bras. cardiol ; 116(5): 959-967, nov. 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1248915
RESUMO
Resumo Fundamento Para pacientes com infarto do miocárdio com elevação do segmento ST (IAMCST) que sofrem de obstrução coronariana microvascular funcional e estrutural (OCM) subsequente, nenhuma abordagem terapêutica específica e definitiva de atenuação foi comprovada como válida em testes de larga escala atuais, o que destaca a necessidade de abordar seu reconhecimento precoce.

Objetivos:

Este estudo teve como objetivo comparar o desempenho de dois escores de risco clínico com uma medida objetiva de OCM durante intervenção coronária percutânea (ICP) em casos de IAMCST

Métodos:

A medição do índice de resistência microcirculatória (IRM) foi realizada e os parâmetros clínicos e angiográficos basais também foram registrados. Os pacientes foram divididos em entre os grupos OM (obstrução microvascular) e NOM (não-obstrução microvascular), de acordo com o valor de IRM pós-procedimento. O risco de OCM foi avaliado para todos os participantes pelos escores preditivos SAK e ATI, respectivamente. Cada sistema foi calculado somando-se as pontuações de todas as variáveis. As curvas de características do operador receptor (ROC) e a área sob a curva (AUC) de dois modelos de risco foram utilizadas para avaliar o desempenho discriminatório. Um ecocardiograma foi realizado sete dias após o procedimento para avaliar a fração de ejeção do ventrículo esquerdo (FEVE). Um valor P bicaudal de <0,05 foi considerado estatisticamente significativo.

Resultados:

Entre os 65 pacientes elegíveis com IAMCST, 48 foram alocados no grupo NOM e 17 no grupo OM, com uma incidência de OCM de 26,15%. Não houve diferença significativa na AUC entre os dois escores. A FEVE avaliada para o grupo NOM foi maior do que para o grupo OM.

Conclusão:

Os escores SAK e ATI tiveram bom desempenho para estimar o risco de OCM após ICP primário para pacientes com IAMCST.
ABSTRACT
Abstract

Background:

For patients with ST-segment elevation myocardial infarction (STEMI) that are suffering from subsequent coronary microvascular functional and structural obstruction (CMVO), no specific and definitive therapeutic approaches of attenuation have been proven valid in up-to-date large-scale tests, which highlights the urge to address its early recognition.

Objectives:

This study aimed to compare the performance of two clinical risk scores with an objective measurement of CMVO during percutaneous coronary intervention (PCI) with STEMI.

Methods:

The Index of Microcirculatory Resistance (IMR) measurement was conducted and the baseline clinical and angiographic parameters were also recorded. The patients were divided into MO (Microvascular obstruction) or NMO (Non-microvascular obstruction) groups according to the post-procedure IMR value. The CMVO risk was evaluated for all participants by SAK and ATI predictive scores, respectively. Each system was calculated by summing the scores of all variables. The receiver operator characteristic (ROC) curves and the area under the curve (AUC) of two risk models were used to evaluate the discriminatory performance. An echocardiography was performed seven days after the procedure to evaluate left ventricular ejection fraction (LVEF). A two-sided P-value of <0.05 was considered statistically significant.

Results:

Among the 65 eligible STEMI patients, 48 patients were allocated in the NMO group and 17 in the MO group, with a CMVO incidence of 26.15%. There was no significant difference in the AUC between both scores. The LVEF evaluated for the NMO group was higher than that of MO group.

Conclusion:

Both SAK and ATI scores performed well in estimating CMVO risk after primary PCI for STEMI patients.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction Type of study: Etiology study / Prognostic study / Risk factors Limits: Humans Language: English / Portuguese Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2021 Type: Article Affiliation country: China Institution/Affiliation country: Hebei General Hospital/CN / Second Hospital of Hebei Medical University/CN

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Full text: Available Index: LILACS (Americas) Main subject: Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction Type of study: Etiology study / Prognostic study / Risk factors Limits: Humans Language: English / Portuguese Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2021 Type: Article Affiliation country: China Institution/Affiliation country: Hebei General Hospital/CN / Second Hospital of Hebei Medical University/CN