TCT-240 A-SMART-EF: A Novel Score to Predict Mortality in Patients Undergoing Impella-Assisted Percutaneous Coronary Intervention

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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)

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