Clinical Prediction Model For Successful Thrombus Aspiration In Acute ST-Segment Elevation Myocardial Infarction With PPCI

Objection:To determine whether pre-procedure biochemistry improves the predictive value of the thrombus aspiration success score(DDTA score)by observing the impact of biochemical parameters and baseline information on thrombus aspiration(TA)outcomes in patients with acute ST-segment elevation myocardial infarction before emergency PCI.To provide a basis for cardiovascular interventionalists to assess the success rate of thrombus aspiration in patients with STEMI during PPCI.Method:A total of 226 patients with acute ST-segment elevation myocardial infarction treated with PPCI and evaluated by an interventionalist for thrombus aspiration at Sino-Japanese Friendship Hospital of Jilin University from January 2017 to December 2019 were selected.Of these,226 patients underwent thrombus aspiration;116 patients were eliminated from the study because the data were insufficient;and 110 patients were included.Based on whether TIMI class 3 flow was restored following manual thrombus aspiration prior to PCI,patients with STEMI were split into a successful aspiration group and a failed aspiration group.Prior to surgery,all biochemical values were gathered.Results:The results of a univariate logistic regression study revealed that MONO(OR=0.025,95% confidence interval:0.001-0.518,P=0.025),NLR(OR=0.916,95% confidence interval:0.840-0.998,P =0.045),neutrophil count(OR=1.087,95% confidence interval: 0.980-1.205,P = 0.114),and DDTA score(OR = 1.443,95% confidence interval 1.126-1.850,P = 0.004)were all correlates of aspiration success.A multivariate logistic regression analysis revealed that DDTA score(OR=1.498,P<0.05),MONO(OR=0.025,P<0.05),neutrophil count(OR=0.025,P<0.05),and neutrophil-to-lymphocyte ratio(NLR)(OR=0.025,P<0.05)were independent predictors of successful thrombus aspiration.independent predictor of thrombus aspiration success.The joint predictive score(AUC=0.781;P=0.000),maximum cutoff value of 0.79,sensitivity of 54.1%,and specificity of 91.7% were obtained by receiver operating characteristic curve(ROC)analysis.The calibration curve was used to evaluate the model prediction accuracy,suggesting that the simulated curve and the actual curve trend were in general agreement.DCA is a demonstration of the clinical utility of the model based on continuous potential risk thresholds and the net benefit of using the model to risk-stratify patients,with DCA showing that the model yields better clinical benefit when the threshold probability is between 9% and 97%.Conclusion1.The results show that for STEMI patients undergoing PPCI,a lower age,shorter time delay,and pretreatment can improve the success rate of thrombus aspiration.2.DDTA score,monocyte count,neutrophil-to-lymphocyte ratio,and neutrophil count were all independent predictors of aspiration success.3.Better joint prediction than DDTA score alone.