Gensini score and thrombus burden add predictive value to the syntax score in detecting no-reflow after myocardial infarction

Abstract

Background: No-reflow after percutaneous coronary intervention is associated with poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). SYNTAX score is a good predictor of no-reflow. Objective: We aimed to evaluate whether atherosclerotic burden (Gensini score) and thrombus burden in the culprit coronary artery would improve the ability of the SYNTAX score to detect no-reflow. Methods: In this prospective cohort study, consecutive patients with STEMI who presented within 12 h of onset of symptoms were selected for this study. No-reflow was defined as TIMI flow < 3 or TIMI flow = 3 and myocardial blush grade <2. Thrombus burden was quantified according to the TIMI thrombus grade scale (0 to 5). Results: A total of 481 patients were included (mean age 61±11 years). No-reflow occurred in 32.8%. SYNTAX score (OR=1.05, 95%CI 1.01–1.08, p<0.01), thrombus burden (OR=1.17, 95%CI 1.06–1.31, p<0.01), and Gensini score (OR=1.37, 95%CI 1.13–1.65, p<0.01) were independent predictors of no-reflow. Combined scores had a larger area under the curve than the SYNTAX score alone (0.78 [0.73–0.82] vs 0.73 [0.68–0.78], p=0.03). Analyses of both categorical (0.11 [0.01–0.22], p=0.02), and continuous net reclassification improvement (NRI>0) (0.54 [0.035–0.73], p<0.001) showed improvement in the predictive ability of no-reflow in the combined model, with integrated discrimination improvement (IDI) of 0.07 (0.04–0.09, p<0.001). Conclusions: Our findings suggest that, in patients with STEMI undergoing percutaneous coronary intervention, atherosclerotic burden and thrombus burden in the culprit artery add predictive value to the SYNTAX score in detecting the no-reflow phenomenon.