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SNOPI score (Score of NO-reflow in Primary angIoplasty) as a predictor of No-Reflow phenomena after primary angioplasty
Session:
Painel 11 - Cardiologia Intervenção 2
Speaker:
Diogo Brás
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters
FP Number:
---
Authors:
Diogo Brás; Mafalda Carrington; Rita Caldeira Da Rocha; Antonio; Bruno Cordeiro Piçarra; José Eduardo Aguiar; RNSCA
Abstract
<p>INTRODUCTION</p> <p>No-reflow phenomenon is defined as a complex condition associated with inadequate myocardial reperfusion without angiographic evidence of epicardial vessel obstruction, spasm or dissection. Due to its consequences, it would be ideal to predict its occurrence. But, to date, the predictors of the no-reflow phenomenon remain poorly established. </p> <p>PURPOSE</p> <p>We sought to study the SNOPI score as a predictor of NR, intra-hospital mortality (IHM), reinfarction, complications and 1-year mortality, in patients that underwent primary angioplasty.</p> <p>METHODS</p> <p>This retrospective study is composed of a sample of 5764 patients, derived from a national multicentre registry. We have included patients with ST-segment elevation myocardial infarction (STEMI) that underwent PPCI.</p> <p>NR is defined by a TIMI flow <3 after PCI.</p> <p>Regarding the creation of the score, first we tested 13 plausible variables with univariate analysis. Then we selected the statistical significant ones, performed a multivariate analysis reporting odds ratio (OR) and built the score. The SNOPI score is defined as follows:</p> <ul> <li>Left ventricle ejection fraction (LVEF) <40%: 2 points (p)</li> <li>Killip class ≥2: 3p</li> <li>Age ≥65 years: 2p</li> <li>Occluded infarct-related artery: 3p</li> <li>Multivessel disease: 1p</li> </ul> <p>The outcome complications is composed endpoint of heart failure, sustained ventricular tachycardia, mechanical complication or cardiac arrest, during hospitalization. We assessed the prediction quality through ROC curve and optimal cut-off point. We also studied the 1-year mortality and rehospitalisation between patients with SNOPI score higher and lower than the optimal cut-off point, using Kaplan-Meier and Log-rank analysis.</p> <p>RESULTS</p> <p>The sample mean age is 63±14 and it is composed by 77% of males.</p> <p>The mean SNOPI score was. The composing variables are described in the table 1.</p> <p>The c-statistic for the outcome NR performed fairly: 0.709 (.644-.774), as for complications: 0.758 (.740-.775). It performed good for IHM: 0.861 (.829-.892). It performed poorly for reinfarction: 0.622 (.538-.707). The optimal cut-off point for NR was 6 (sens 60%, spec 70%, negative predictive value 99%, PPV 3%).</p> <p>The survival analysis showed a significant Log-rank analysis for the composed endpoint of rehospitalisation/1-year mortality for patients with SNOPI <6 versus ≥6 (10% vs 21%, p<.001).</p> <p> </p> <p>CONCLUSION</p> <p>We conclude that SNOPI score is a very good test to acknowledge which patients will not suffer NR, as it is shown by its very high NPV (99%). It is a good test to predict IHM in patients that undergo PPCI. The SNOPI score also predicts rehospitalisation/1-year mortality, as it is shown by the survival analysis of the populations with scores higher and lower than the optimal cut-off point.</p> <p>This score may contribute to estimate the development of no-reflow in the pre-PCI period, risk stratification, complications and cardiovascular outcomes.</p>
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