DOI: 10.54996/anatolianjem.1871675 ISSN: 2651-4311

Prognostic Value of Laboratory Biomarkers and Risk Scores in STEMI Patients Presenting to the Emergency Department Undergoing Manual Thrombus Aspiration

Recep Sami Özay, Melih Yüksel, Barış Şensoy, Mehmet Oğuzhan Ay, Yeşim İşler, Halil Kaya, Umut Ocak, Abdurrahman Sadullah Akyıldız
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Aim: Early risk stratification in the emergency department (ED) is critical for patients presenting with ST-elevation myocardial infarction (STEMI). This study aimed to evaluate the prognostic performance of commonly used clinical risk scores (TREWS, REMS, TIMI, and C-ACS) and readily available laboratory ratios, including the D-dimer/Albumin ratio (DAR) and Blood Urea Nitrogen/Albumin ratio (BAR), for short-term outcomes in STEMI patients presenting to the ED who subsequently underwent manual thrombus aspiration (MTA) during percutaneous coronary intervention (PCI).Material and Methods: This prospective, single-center study included consecutive STEMI patients presenting to the ED between February 2023 and January 2024. Patients who underwent MTA during PCI were analyzed. The ability of clinical scores and laboratory ratios obtained during the initial ED evaluation to predict 28-day all-cause mortality, recurrent acute coronary syndrome (ACS), and stroke was assessed using receiver operating characteristic (ROC) curve analysis.Results: Among 363 STEMI patients, 30 (8.3%) underwent MTA. MTA was more frequently performed in patients with anterolateral and posterolateral STEMI. Significant differences were observed in age, REMS, and C-ACS scores between patients who did and did not undergo MTA. The TIMI score differed significantly across STEMI localization subgroups. BAR demonstrated excellent prognostic performance for 28-day mortality (AUC = 0.889; 95% CI: 0.766–1.000; p < 0.05). None of the evaluated scores or laboratory ratios reliably predicted recurrent ACS or stroke.Conclusion: Among the evaluated laboratory biomarkers and clinical scores, BAR demonstrated the highest prognostic performance for predicting 28-day mortality in STEMI patients undergoing MTA. These findings suggest that BAR, a simple and rapidly available laboratory parameter, may assist emergency physicians in early risk stratification of high-risk STEMI patients, whereas traditional risk scores showed limited utility for predicting short-term non-fatal outcomes.

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