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Background: Angiographic no‐reflow is associated with poor outcomes in patients with ST‐segment elevation myocardial infarction (STEMI). We sought to develop and validate a score system to predict angiographic no‐reflow in primary percutaneous coronary intervention (PCI). Methods: ST‐segment elevation myocardial infarction patients undergoing primary PCI were consecutively enrolled and were randomly divided into the training and validation set. Angiographic no‐reflow was defined as thrombolysis in myocardial infarction (TIMI) flow grade 0 to 2 after PCI. In the training set, independent predictors were identified by logistic regression analysis, and a score system (PredIction of Angiographic NO‐reflow, the PIANO score) was constructed based on the β‐coefficient of each variable. The established model was evaluated for discrimination and calibration. Results: Angiographic no‐reflow occurred in 362 (17.8%) of 2036 patients. Age ≥70 years, absence of pre‐infarction angina, total ischaemic time ≥4 h, left anterior descending as culprit artery, pre‐PCI TIMI flow grade ≤1 and pre‐PCI TIMI thrombus score ≥4 were independent predictors of angiographic no‐reflow. The PIANO score ranged from 0 to 14 points, yielding a concordance index of 0.857 (95% confidence interval: 0.833 to 0.880), with good calibration. In the high‐risk (≥8 points) group, the probability of angiographic no‐reflow phenomenon was 38.7%, while it was only 4.8% in the low‐risk (<8 points) group. The score system performed well in the validation set. Conclusions: We establish and validate a score system based on six clinical variables to predict angiographic no‐reflow in STEMI patients undergoing primary PCI, which may help choose the optimal individual treatment strategy. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the prognostic implications of increased post-procedural cardiac troponin levels in patients undergoing elective percutaneous coronary intervention (PCI) and to define the threshold of prognostically relevant periprocedural myocardial injury (PMI)., Methods and Results: A total of 3249 patients with normal baseline troponin levels referred for elective PCI were enrolled and followed up for a median period of 20 months. The primary endpoint was major adverse cardiovascular events (MACEs) comprising all-cause death, myocardial injury (MI), and ischaemic stroke. Post-PCI high-sensitivity cardiac troponin T (hs-cTnT) >99% upper reference limit (URL) occurred in 78.3% of the patients and did not increase the risk of MACEs [adjusted hazard ratio (adHR) 1.00, 95% confidence interval (CI) 0.58-1.74, P = 0.990], nor did 'major PMI', defined as post-PCI hs-cTnT >5× URL (adHR 1.30, 95% CI 0.76-2.23, P = 0.340). Post-PCI troponin >8× URL, with an incidence of 15.2%, started to show an association with a higher risk of MACEs (adHR 1.89, 95% CI 1.06-3.37, P = 0.032), mainly driven by myocardial infarction (adHR 2.38, 95% CI 1.05-5.38, P = 0.037) and ischaemic stroke (adHR 3.35, 95% CI 1.17-9.64, P = 0.025)., Conclusion: In patients with normal baseline troponin values undergoing elective PCI, PMI defined as hs-cTnT >8× URL after PCI was more appropriate for identifying patients with an increased risk of MACEs, which may help guide clinical practice in this population., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)