Prognostic value of the revascularization index in ST-segment elevation myocardial infarction

• Frolov A.A.
• Sharabrin E.G.
• Fomin I.V.
• Pochinka Ilya G.
• Savenkov A.G.

Abstract

Aim. To evaluate prognostic value of the revascularization index (RI) in ST-segment elevation myocardial infarction (STEMI).

Methods. A single-center prospective observational study was conducted. Included 127 STEMI patients without previous coronary anamnesis which admitted successively, 90 (71%) men and 37 (29%) women, the average age is 59.8±13.6 years. Percutaneous coronary intervention (PCI) was performed in 66 (52%) cases. The result of the percutaneous coronary intervention (PCI) was evaluated with the BCIS-1 Myocardial Jeopardy score (JS). On the basis of JS was calculated RI: (JS before PCI - JS after PCI)/JS before PCI. The range of possible RI values is from 0.0 to 1.0, step 0.1. In cases where PCI was not performed, the RI was considered equal to0.0. The development of major adverse cardiac events (MACE: cardiac death, nonfatal myocardial infarction, target vessel revascularization, stent thrombosis) was monitored during the 12-month follow-up period.After 12 months, the following tests were performed: 6-minute walk test (6MWT), echocardiography withmeasurement of the left ventricular ejection fraction (EF), analysis for N-terminal fragment of the brain natriuretic peptide (NT-proBNP), evaluation of chronic heart failure (CHF) class according NYHA classification and quality of life analysis using the EQ-5D-3L questionnaire (EuroQol Group).The quantitative data are presented as median and interquartile intervals (Median [Q1; Q3]). The RIcut-off value is 0.3 (sensitivity 74%, specificity 83%).

Results. During the 12-month follow-up period, 18 (14.2%) patients died, MACE was registered in 31 (25%) subjects. Clinically significant CHF (II-IV class) was formed in 68 (54%) patients. The combined endpoint MACE and/or II-IV class of CHF (MACE/CHF) was registered in 86 (68%) cases. In patients who develop MACE/CHF, RI was 0.0 [0.0; 0.5], in patients without MACE/CHF - 1,0 [0,5; 1,0], p<0,001. The RI correlated with 6MWT result (Я=0.46, p=0.01), EQ VAS value (Я=0.35, p=0.01), and NT-proBNP level (fl=-0.44 , p=0.05) is estimated after 12 months.ROC-analysis confirmed the significance of RI as a MACE/CHF predictor (AUC = 0.803, p<0.001). According to the results of multifactoriallogistic regression analysis,RIvalue more 0.3 significantly reduce the risk of MACE/CHFdevelopment (OR 0.08, 95% CI is0.02 to 0.30, p<0.001).

Conclusions. The RI value is associated with MACE development, CHF formation and quality of life reduction during 12 months after STEMI.The study results indicate the advantage of complete one-stage revascularization tactics in STEMI patients with multivessel coronary artery disease.

Keywords:coronary artery disease, ST-segment elevation myocardial infarction, percutaneous coronary intervention, revascularization index, prediction of adverse outcomes

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