Prediction Score Project for the Incidence of Cerebrovascular Events in Patients with Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

2020 ◽  
Author(s):  
Xiaoxiao Zhao ◽  
Chen Liu ◽  
Peng Zhou ◽  
Zhaoxue Sheng ◽  
Jiannan Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Prediction Score ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary

Prediction Score Project for the Incidence of Cerebrovascular Events in Patients With Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Xiaoxiao Zhao ◽  
Chen Liu ◽  
Peng Zhou ◽  
Zhaoxue Sheng ◽  
Jiannan Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Prediction Model ◽  
Risk Score ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary ◽  
History Of

Abstract BackgroundWe sought to develop and validate a novel marker-based risk score to improve stroke prognostication in patients with myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI).MethodsA retrospective study was conducted and internally validated a new biomarker-based risk score for the incidence of stroke in 4103 patients with MI undergoing primary PCI who were randomized into a derivation and a validation cohort. Predictive values of markers and clinical variables were evaluated using Cox regression models and least absolute shrinkage and selection operator regression. The most important variables were included in the score, with weight proportional to the model coefficients.ResultsSignificant predictors of the incidence of cerebrovascular events were age, history of atrial fibrillation, history of hypertension, Killip class, blood pressure group, target lesion involving branches, percutaneous transluminal coronary angioplasty, and thrombus aspiration. The models had good calibration and discrimination in derivation and internal validation. The areas under the curve (AUC) of the receiver operating characteristic (ROC) curve analysis for predicting cerebrovascular events were 0.773 and 0.766 for the derivation and validation cohorts, respectively, at 5-year follow-up. Survival ROC curves exported the best cut-off values and divided them into low-risk and high-risk groups using the R language. We conducted Kaplan–Meier survival analysis for the two groups. Both groups displayed significant difference in the derivation and validation cohorts (P=0.00003 and P=0.009, respectively). We compared the new prediction model to the CHADS-VASc score; the AUCs were 0.773 and 0.754, respectively.ConclusionThe prediction model was internally validated and calibrated in large cohorts of patients with MI receiving primary PCI therapy. This risk score incorporates allows re-evaluation of the risk of cerebrovascular events after undergoing primary PCI.

Optimum Therapies for ST-Elevation Myocardial Infarction Managed with Primary Percutaneous Coronary Intervention

2012 ◽  
Vol 7 (2) ◽  
pp. 81
Author(s):  
Bruce R Brodie ◽  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Great Majority ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Stent Deployment ◽  
Aspiration Thrombectomy ◽  
Percutaneous Coronary ◽  
St Elevation

This article reviews optimum therapies for the management of ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Optimum anti-thrombotic therapy includes aspirin, bivalirudin and the new anti-platelet agents prasugrel or ticagrelor. Stent thrombosis (ST) has been a major concern but can be reduced by achieving optimal stent deployment, use of prasugrel or ticagrelor, selective use of drug-eluting stents (DES) and use of new generation DES. Large thrombus burden is often associated poor outcomes. Patients with moderate to large thrombus should be managed with aspiration thrombectomy and patients with giant thrombus should be treated with glycoprotein IIb/IIIa inhibitors and may require rheolytic thrombectomy. The great majority of STEMI patients presenting at non-PCI hospitals can best be managed with transfer for primary PCI even with substantial delays. A small group of patients who present very early, who are at high clinical risk and have long delays to PCI, may best be treated with a pharmaco-invasive strategy.

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