The predictive value of CatLet© angiographic scoring system for long-term prognosis in patients with acute myocardial infarction presenting > 12 h after symptom onset

Abstract

Background: We have recently developed the C oronary A rtery T ree description and L esion E valua T ion (CatLet©) angiographic scoring system, which is capable of accounting for the variability in coronary anatomy, and risk-stratifying patients with coronary artery disease. This study aimed to clarify whether the CatLet score had a predictive value for long-term prognosis in patients with acute myocardial infarction (AMI) presenting > 12 h after symptom onset.

Materials and methods: The CatLet score was calculated for 1,018 consecutively enrolled AMI patients, who were divided into 3 groups according to the CatLet score tertiles. The primary endpoint was major adverse cardiac events (MACEs), defined as a composite of myocardial infarction, cardiac death, and ischemia-driven revascularization; secondary endpoints were all-cause death, cardiac death, myocardial infarction, and ischemia-driven revascularization.

Results: The CatLet score was capable of predicting long-term prognosis at a median 4.9-year follow-up alone or after adjustment for risk factors. Multivariable-adjusted hazard ratios (95% CI)/unit higher score were 1.06 (1.05-1.08) for MACEs, 1.05 (1.03-1.07) for all-cause death, 1.06 (1.04-1.09) for cardiac death, 1.06 (1.04-1.08) for myocardial infarction, and 1.06 (1.04-1.08) for revascularization. The univariate model showed good calibration (χ² = 8.25, P = 0.4091) and good discrimination (area under ROC curve = 0.7086) for MACEs.

Conclusion: The CatLet score is an independent predictor of long-term clinical outcomes of patients with AMI presenting > 12 h after symptom onset (http://www.chictr.org.cn; Registry Number: ChiCTR2000033730).

Keywords: Percutaneous Coronary Intervention; acute myocardial infarction; angiographic score; major adverse cardiac events; prognosis.

FIGURE 1

Kaplan–Meier curves for clinical outcomes at 5 years according to the CatLet score tertiles. MACE, major adverse cardiac events.

FIGURE 2

The ROC curves of univariate models for clinical outcomes. MACE, major adverse cardiac events; AUC, Receiver Operating Characteristic (ROC) curve; and CI, confidence interval.

FIGURE 3

Calibration plots of univariate models for clinical outcomes. A red lowess smoothing curve was added to each calibration plot. Intercept of 0 and slope of 1 indicate perfect prediction. Negative and positive intercepts indicate overestimation and underestimation, respectively. MACE, major adverse cardiac events; HL, Hosmer-Lemeshow test.

FIGURE 4

Hazard ratios for MACEs per 10 units higher CatLet score stratified by risk factors, categorically or medially. LDL-c, low density lipoprotein cholesterol; HDL-c, high density lipoprotein cholesterol; Lp(a), lipoprotein(a); TG, triglycerides; and TC, total cholesterol.