Alejandro Lemor, MD: A-SMART-EF Score

Alejandro F. Lemor, MD, an interventional cardiologist at Henry Ford Hospital in Detroit, disusses a new risk score for Impella-supported high-risk PCI. Dr. Lemor explains that the motivation behind looking  at data to create this formula was to have something like the surgeon’s STS score to predict outcomes in patients undergong high-risk PCI supported with mechanical circulatory support (MCS).

Dr. Lemor reports that using data from patients who underwent high-risk PCI and were supported with Impella® in the PROTECT III study, he and his colleagues were able to analyze factors predicting 90-day mortality.“And we actually found that there are 7 factors that if you add them up, you can actually stratify patients into two different mortality groups.”

The score that Dr. Lemor presents is called A-SMART-EF.

• “A” is for age
• “S” is for SYNTAX score
• “M” is for myocardial infarction
• “A” is for anemia (Hgb <12 mg/dL)
• “R” is for renal dysfunction
• “T” is for tobacco use
• “EF” is for ejection fraction (EF) less than 35%

SYNTAX score and EF<35% are each worth 2 points and the others are worth 1 point each. The two groups Dr. Lemor identified were patients with a score between 0 and 5, and patients with a score of 6 to 9. Results showed that mortality in patients scoring 0-5 was three times lower than mortality in patients scoring 6-9. He concludes that the A-SMART-EF score can help identify which patients (patients with A-SMART-EF scores of 6-9) will have higher 90-day mortality.