The Value Of The CatLet(?) Angiographic Scoring System In Predicting 30-day MACEs For Patients With Acute Myocardial Infarction

Objective:To evaluate the value of Coronary Artery Tree description and Lesion EvaluaTion(CatLet(?))system in predicting the major adverse cardiovascular events(MACEs)in patients with acute myocardial infarction(AMI)with chest pain>12 hours.Background:Recently,our study team has independently developed the CatLet angiographic scoring system based on the 17 myocardial segmental model,law of competitive blood supply and law of flow conservation.This CatLet score can describe the variable coronary artery anatomy,evaluate the lesions’ severity,and semi-quantify the myocardial territory subtended by the diseased coronary artery.Studies have shown that the CatLet angiographic scoring system has a predictive value for the long-term prognosis in patients with AMI receiving percutaneous coronary intervention(PCI).However,the predictive value of the CatLet score for the short-term prognosis in AMI patients with chest pain>12 hours has not been reported.Methods:This study consecutively enrolled 1018 acute myocardial infarction patients with chest pain>12 hours,and calculated the CatLet score in non-occlusive status if appropriate.The CatLet score were tertile partitioned:CatLet low:≤12 points;CatLet mid:12-19 points;and CatLet top:≥19 points.The primary endpoint was major adverse cardiovascular event(MACE).The association between the CatLet score and MACEs was investigated by COX univariate and multivariate regression analysis and sensitivity analysis.The predictive value of the CatLet angiographic scoring system for MACEs was described by the Receiver Operating Characteristic(ROC)Curve and the Area Under the Curve(AUC).The goodness of fit of the model was assessed by the Hosmer-Lemeshow test.The z test was used for evaluating the impact of the interaction between the CatLet score and clinical variables on MACEs.Results:There were 57 patients having MACEs in the 1018 patients enrolled.In the univariate analysis,the CatLet score had a great predictive value for MACEs whatever as a continuous variable(HR(95%CI),1.11(1.08-1.14))or as a categorical variable(HR(95%CI),1.80(0.64-5.04)in the CatLet mid;HR(95%CI),8.22(3.50-19.35)in the CatLet top)(P value<0.01),and the similar results were obtained in the multivariate analysis.The Keplan-Meier survival curves showed that the event-free survival rate within 30 days was 87%in the CatLet top,97%in the CatLet mid,and 98%in the CatLet low,with the significant difference(P value for Log-rank test<0.001).The ROC curve of the CatLet score on MACEs showed that the CatLet score could predict the occurrence of MACEs,with the AUC=0.76(95%CI,0.70-0.83).Hosmer-Lemeshow test confirmed that the CatLet angiographic scoring system model had a good calibration(x 2=7.78,P-value=0.45).Finally,the subgroup analysis showed that the impact of the CatLet score on MACEs was consistent in different subgroups,and there was no significant interaction between the CatLet score and clinical risk factors.Conclusion:The CatLet angiographic scoring system has a predictive value on MACEs within 30 days in patients with AMI with chest pain>12 hours.Patients with CatLet score≥19,with ≈10 myocardial segments involved,accounting for 60%of left ventricle,have been associated with poor prognosis.