Prognostic value and clinical usefulness of PIANO score in patients undergoing primary percutaneous coronary intervention.
Prognostic value and clinical usefulness of PIANO score in patients undergoing primary percutaneous coronary intervention.
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DOI：
10.1016/j.ijcard.2023.131258
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发表时间：
2023-08
影响因子：
3.5
通讯作者：
C. Dai;Zheng Yang;Muyin Liu;You Zhou;Danbo Lu;Shufu Chang;Chenguang Li;Haojie Lu;Zhangwei Chen;J. Qian;Junbo Ge
中科院分区：
文献类型：
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作者：
C. Dai;Zheng Yang;Muyin Liu;You Zhou;Danbo Lu;Shufu Chang;Chenguang Li;Haojie Lu;Zhangwei Chen;J. Qian;Junbo Ge
背景在我们以前的研究中，PIANO评分被用来预测直接经皮冠状动脉介入治疗（PCI）患者无复流现象的发生。在目前的分析中，我们试图评估的预后价值和临床实用性的PIANO评分在此population.MethodsPatients急性心肌梗死（AMI）进行直接PCI连续登记，并在此登记随访。关注的终点是术后2年的全因死亡率。在某些亚组的直接PCI血栓抽吸（TA）的临床效益也进行了评估，作为探索性analysis.ResultsA共2100例患者被确定，和54.3%的高（≥8）PIANO评分。2年随访后，PIANO评分高的患者在调整倾向评分后的全因死亡风险较高（6.7% vs. 3.1%，调整后风险比= 2.11 [1.21-3.68]，p= 0.008），尤其是在第一个月（调整后风险比= 2.33 [1.17-4.65]，p= 0.017）。限制性三次样条分析表明PIANO评分与2年全因死亡率之间存在线性相关性（非线性p = 0.556）。进一步的分析表明，TA并没有降低所有患者的全因死亡率，以及那些有可见血栓、高血栓负荷或闭塞性病变的患者的全因死亡率。结论PIANO评分对AMI直接PCI患者有潜在的预后价值。它也可能有助于识别从TA中受益的患者。这些观察结果需要在未来的研究中进一步证实。
BackgroundIn our previous study, the PIANO score was constructed to predict the occurrence of no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (PCI). In the current analysis, we sought to evaluate the prognostic value and clinical usefulness of the PIANO score in this population.MethodsPatients with acute myocardial infarction (AMI) undergoing primary PCI were consecutively enrolled and followed up in this register. The endpoint of interest was all-cause mortality at 2 years after the procedure. The clinical benefits of thrombus aspiration (TA) during primary PCI in certain subgroups were also evaluated as exploratory analyses.ResultsA total of 2100 patients were identified, and 54.3% had high (≥8) PIANO score. After 2-year follow-up, patients with high PIANO score had higher risk of all-cause mortality after adjustment for propensity score (6.7% vs. 3.1%, adjusted hazard ratio = 2.11 [1.21–3.68],p= 0.008), especially in the first month (adjusted hazard ratio = 2.33 [1.17–4.65],p= 0.017). Restricted cubic spline analysis indicated the linear association between the PIANO score and 2-year all-cause mortality (nonlinearp= 0.556). Further analysis demonstrated that TA did not reduce all-cause mortality in the overall patients, as well as in those with visible thrombus, high thrombus burden, or occlusive lesions. However, the PIANO score defined “high-risk” (PIANO score ≥ 8) patients could benefit from it.ConclusionsThe PIANO score had potential prognostic value in patients with AMI undergoing primary PCI. It might also be helpful for identifying patients who would benefit from TA. These observations require further confirmation in future studies.