CatLet© score for estimation of benefits of percutaneous coronary intervention versus optimal medical therapy in patients with acute myocardial infarction

Background The recently developed the Coronary Artery Tree description and Lesion EvaluaTion (CatLet©) angiographic scoring system has adequately accounted for the variability in coronary anatomy and considered both the severity of a coronary artery stenosis and its subtended myocardial territory. This study aims to investigate its potential roles played in guiding treatment strategies. Methods A total of consecutive 544 acute myocardial infarction (AMI) patients with single vessel disease were enrolled and their CatLet scores were calculated. The patients were divided into two groups: high (≥10) or low (< 10) CatLet score group. The primary endpoint was all-cause death. Cox regression survival analysis was performed to determine the benefits of percutaneous coronary intervention (PCI) versus optimal medical therapy in each group. Results The survival rate of all-cause death in the low CatLet score group was similar regardless of whether PCI was performed (P = 0.86). However, in the high CatLet score group, the survival rate was significantly higher when PCI was performed as compared to those whose PCI was not performed (P = 0.0067). The multivariable-adjusted hazard ratios (95% CI, P) were 0.20 (0.07–0.62, P = 0.005) for PCI in higher CatLet score group and 6.96 (0.22-205.65, P = 0.277) in lower CatLet score group. Conclusions The CatLet angiographic scoring system, capable to semi-quantify the myocardial territory, can be a useful tool to guide the treatment strategy for patients with AMI. Those with a CatLet score≥10 or more than five myocardial segments involved (CatLet score divided by the coefficient of 2) would benefit from the PCI strategy (http://www.chictr.org.cn; Registry Number: ChiCTR2000033730).