<b><i>Background:</i></b> We recently developed the Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system. Our preliminary study demonstrated that the CatLet score better predicted clinical outcomes than the SYNTAX score. The current study aimed at assessing whether 3 clinical variables (CVs) – age, serum creatinine, and left ventricular ejection fraction (LVEF) – improved the performance of the CatLet score in outcome predictions in patients with acute myocardial infarction (AMI). <b><i>Methods:</i></b> This study was a post hoc study of the CatLet score validation trial. Primary endpoint was major adverse cardiac or cerebrovascular events (MACCEs), and secondary endpoints were all-cause deaths and cardiac deaths. <b><i>Results:</i></b> Over 1,185 person-years (median [interquartile range], 4.3 [3.8–4.9] years), there were 64 MACCEs (20.8%), 56 all-cause deaths (18.2%), and 47 cardiac deaths (15.2%). The addition of the 3 CVs to the stand-alone CatLet score significantly increased the Harrell’s C-index by 0.0967 (<i>p</i> = 0.002) in MACCEs, by 0.1354 (<i>p</i> &#x3c; 0.001) in all-cause deaths, and by 0.1187 (<i>p</i> = 0.001) in cardiac deaths. When compared with the stand-alone CatLet score, improved discrimination and better calibration led to a significantly refined risk stratification, particularly at the intermediate-risk category. <b><i>Conclusions:</i></b> CatLet score had a predicting value for clinical outcome in AMI patients. This predicting value can be improved through a combination with age, serum creatinine, and LVEF (http://www.chictr.org.cn; unique identifier: ChiCTR-POC-17013536).

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Background: Possible interaction between Lipoprotein (a) (Lp(a)) and body mass index (BMI) was investigated with regard to the risk of first incident acute myocardial infarction (AMI). Methods: Cross-sectional study of 1522 cases with initial AMI and 1691 controls without coronary artery disease (CAD) were retrospectively analyzed using logistic regression model. Subjects were categorized based on Lp(a) and BMI and compared with regard to occurrence of AMI by calculating odds ratios (ORs) with 95% confidence intervals (CIs). A potential interaction between Lp(a) and BMI was evaluated by the measures of effect modification on both additive (Relative excess risk due to interaction, RERI) and multiplicative scales. Results: Compared with reference group (BMI < 24 kg/m 2 and in the first quintile of Lp(a)), multivariable-adjusted analysis revealed that ORs(95%CI) of AMI were 2.27(1.46-3.52) for higher BMI alone; 1.79(1.11-2.90), 1.65(1.05-2.60), 1.96(1.20-3.20) and 2.34(1.47-3.71) for higher Lp(a) alone across its quintiles; and 2.86(1.85-4.40), 3.30(2.14-5.11), 4.43(2.76-7.09) and 5.98(3.72-9.60) for both higher BMI and higher Lp(a), greater than the sum of the both risks each. Prominent interaction was found between Lp(a) and BMI on additive scale (RERI = 2.45 (0.36-4.54) at the fifth quintile of Lp(a)) but not on multiplicative scale. Conclusions: This study demonstrates that BMI and Lp(a) levels are important factors affecting the risk of AMI. Significant interaction is found between Lp(a) and BMI in initial AMI on additive scale, indicating that Lp(a) confers greater risk for initial AMI when BMI is elevated. For those whose BMIs are inadequately controlled, Lp(a) lowering may be an option. Trial registration: This clinical study was not registered in a publicly available registry because this study was a retrospective study first started in 2015. Data are available via the correspondent.

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Background The Coronary Artery Tree description and Lesion Evaluation (CatLet) score accommodating the variability in the coronary anatomy is a recently develpoed and comprehensive angiographic scoring system aiming to assist in risk-stratification of coronary artery disease patients. Our preliminary study demonstrated that the CatLet score predicted the clinical outcomes in patients with acute myocardial infaration (AMI) undergoing pirmary percutaneous intervention (PCI). Purpose The current study aimed to identify whether the clinical variables (CVs: age, creatinine and left ventricular ejection fraction) additionally improved the performance of the CatLet score with respect to the outcome predictions in AMI undergoing primary PCI. Methods The CatLet score was calculated retrospectively in consecutively enrolled 308 patients with AMI. The primary end point was major adverse cardiac or cerebrovascular events (MACCEs) at median 4.3-years. Secondary endpoints were all-cause death and cardiac death. Cox regression survival analysis was uesd to identify the associations between the CatLet score, clinical variables and the clinical outcomes. Discrimination was assessed by Harrell's C index, net reclassification improvement (NRI) and calibration was assessed by Hosmer-Lemeshow test and validation plots. Results The CatLet score remained a significant predictor for outcome predictions at a median 4.3-years follow-up after adjusting for the 3 CVs. The model incorporationg the CatLet score and these 3 CVs (CVs-adjusted model) performed better than the stand-alone CatLet model in terms of outcome predictions. Compared with the stand-alone CatLet model, Harrell's C index with the CVs-adjusted model significantly increased by 0.10 (P=0.002) in MACCE, by 0.14 (P&lt;0.001) in all-cause death events and by 0.12 (P=0.001) in cardiac death events. When reclassifying patients with 4.3 year MACCE from the stand-alone CatLet model into the CVs-adjusted model, out of the 244 subjects who remained free of MACCE events, 101 were correctly reclassified to a lower risk category and 42 were reclassified to a higher risk category (categories: ≤10%, 10% to ≤20%, 20% to ≤40%, &gt;40%); out of the 64 subjects who developed MACCE events, 26 were correctly reclassified to a higher risk category and 10 were reclassified to a lower risk category. The category-based overall NRI was 0.49 (P&lt;0.001) and the continuous overall NRI was 0.74 (P&lt;0.001). Hosmer-Lemeshow tested showed a better calibration in MACCE events in the CVs-adjusted model (X2=4.14, P=0.8440) than in the stand-alone CatLet model (X2=5.06, P=0.7515). Similar findings were found both in all-cause death and cardiac death. Conclusion The 3 CVs (age, creatinine and left ventricular ejection fraction) additionally improved the performance of the CatLet score with respect to the outcome predictions in AMI undergoing primary PCI. (ChiCTR-POC-17013536) Reclassification plot Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Sci-Tech Development Program, Grant/Award