TCT-240 A-SMART-EF: A Novel Score to Predict Mortality in Patients Undergoing Impella-Assisted Percutaneous Coronary Intervention
Recommended Citation
Lemor A, Shah T, Thompson J, Protty M, Mamas M, Kinnaird T, Bharadwaj A, Truesdell A, Zhang Y, Cohen D, Falah B, Redfors B, Baron S, Witzke C, Dixon S, Lansky A, Basir MB, O’Neill W. TCT-240 A-SMART-EF: A Novel Score to Predict Mortality in Patients Undergoing Impella-Assisted Percutaneous Coronary Intervention. J Am Coll Cardiol 2023; 82(17 Suppl):B93-B94.
Document Type
Conference Proceeding
Publication Date
10-24-2023
Publication Title
J Am Coll Cardiol
Keywords
endogenous compound, hemoglobin, adult, anemia, calibration, conference abstract, controlled study, female, glomerulus filtration rate, heart infarction, heart left ventricle ejection fraction, high risk population, human, kidney disease, major clinical study, male, mortality, multicenter study, patient selection, percutaneous coronary intervention, prospective study, risk assessment, SYNTAX score, tobacco use, ventricular assist device
Abstract
Background: Predicting the risk of mortality before a high-risk percutaneous coronary intervention (PCI) is important for patient selection and shared decision-making. Using pre-procedural characteristics, we aimed to create a score to predict the 90-day mortality for these patients. Methods: The study included all patients enrolled in the prospective, multicenter, observational PROTECT III study of Impella-supported high-risk PCI from March 2017 to March 2022. Pre-procedural characteristics were analyzed using univariate and multivariable analysis. Variables with P values <0.1 were included in the risk score and assigned an integer value based on their regression coefficient. Results: A total of 1,237 patients were included. Predictors of 90-day mortality included age >75 years, SYNTAX score ≥33, myocardial infarction on presentation, hemoglobin <12 mg/dL, glomerular filtration rate <60 mL/min/1.73 m2, tobacco use, and left ventricular ejection fraction <35%. The resulting A-SMART-EF (Age >75 years, SYNTAX score ≥33, Myocardial infarction, Anemia, Renal disease, Tobacco use, and Ejection Fraction <35%) risk score is calculated by assigning 1 point to each variable, except for SYNTAX ≥33 and left ventricular ejection fraction <35% (2 points each). Model discrimination (C-statistic 0.65) and calibration were reasonable. When the study population was stratified into low- and high-risk groups (A-SMART-EF score [0-5 vs 6-9]), 90-day mortality was 3 times higher in the high-risk group (6.6% vs 17.9%; HR: 0.35; 95% CI: 0.24-0.52; P < 0.0001). [Formula presented] Conclusion: The A-SMART-EF score is a novel risk assessment tool that can help predict 90-day mortality among patients undergoing Impella-assisted PCI. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)
Volume
82
Issue
17 Suppl
First Page
B93-B94
