Influence of the Residual Gensini Score on Prognosis of Patients With ST‐Elevation Myocardial Infarction

BACKGROUND: The residual Gensini score (rGS) was developed to quantify the severity of coronary atheroma burden after coronary revascularisation. The predictive value of the rGS for clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) remains unexplored. METHODS: Our retrospective study included 1034 consecutive patients who presented with STEMI between 2016 and 2020. Patients were stratified based on the third tertile of rGS values: rGS ≤ 16 (Group 1) and rGS > 16 (Group 2). RESULTS: Compared with patients in group 1, epicardial and microvascular perfusion were significantly impaired in group 2 as evidenced by poorer final flow grade TIMI 3 (89% vs. 74%, p < 0.0001) and lower complete ST resolution (STR) rates > 70% (56% vs. 49%, p = 0.007). In the unadjusted analysis, excess mortality in group 2 was observed early (45-day mortality rate: 6% vs. 12%, p = 0.0005) and persisted during the 2-year follow-up (9% vs. 18%, p < 0.0001). After stabilized Inverse Exposure Probability Weighting (sIEPW) adjustment, the early mortality of the patients was similar in both groups: 45-day mortality: 10% vs. 9%, p = 0.45, Harrell's c-index 40%. However, the rGS remained associated with worse prognosis thereafter: 1 year mortality: 11% versuss 21%, Harrell's c-index: 61%, p < 0.0001. CONCLUSION: In a real-world cohort of patients with STEMI, rGS is associated with a worse long-term prognosis as from 1 year follow-up, but without significantly stratifying early follow-up. These findings provide important insight with regard to the optimal use of angiography scoring system as prognostic factor. (ClinicalTrials.gov Identifier: NCT05679843).