CLINICAL SYNTAX SCORE FOR RISK STRATIFICATION AFTER

ACUTE MYOCARDIAL INFARCTION

Authors: Somkereki Cristina, Dr. Hadadi L.Coordinator: Prof. Dr. Dobreanu D.

Background

Primary percutaneous coronary intervention (pPCI) – recommended treatment of STEMI;

Clinical SYNTAX Score (CSS): a combined risk model integrating angiographic

(SYNTAX Score) and 3 clinical variables;a validated tool for post-PCI risk prediction in

stable coronary artery disease patients;CSS- has never been studied prospectively in the

context of STEMI;

Objective

to test and compare the predictive power of SYNTAX Score (SXS) and CSS for in-hospital mortality in a population of STEMI patients treated with pPCI ;

Material and methodsProspective clinical study during a one-year periodInclusion criteria:

acute ischemic chest pain lasting at least 30 minutes;minimum 1 mm ST segment elevation in at least two contiguous

electrocardiographic leads; primary PCI as reperfusion therapy performed within the first 12 hours

or within 12-24 hours after symptom onset if ischemia still presentExclusion criteria:

previous coronary artery by-pass surgery,thrombolytic therapy before PCIconfounding electrocardiogram (left bundle branch block, paced

rhythm, pre-excitation syndrome, major left ventricular hypertrophy), patient’s refusal for participating in the study

The SYNTAX score algorithm1.Dominance 2.Number of lesions3.Segments involved per lesion Lesion characteristics:4.Total occlusion (number of segments involved; age of total occlusion;

blunt stump; bridging collaterals; first segment beyond the occlusion visible by antegrade or retrograde filling; side branch involvement)

5.Trifurcation(number of segments diseased)6.Bifurcation7.Aorto-ostial lesion8.Severe tortuosity9.Length >20 mm10.Heavy calcification11.Thrombus12.Diffuse disease/small vessels

Clinical SYNTAX ScoreCSS was calculated for each patient using the

formulas:CSS=[SYNTAX Score]*[modified ACEF score].

modified ACEF score =+KK (1→6): creatinine clearance: <60 – k=1

40-50 – k=2<10 – k=6• Overall in-hospital mortality was evaluated according

to low, medium and highSXS and CSS tertiles;

pPCI 7 h after the onset of inferior AMI

Results134 included patients, in-hospital mortality 9.7%

Calculated score values:Low Medium High

SYNTAX <11 (8.0) 11-19.5 (15.75) >19.5 (27.5)Patients – N (%) 45 (33.5) 44 (32.8) 45 (33.5)

CSS <17.4 (9.8) 17.4-39.6 (26.55) >39.6 (65.3)Patients – N (%) 44 (32.8) 46 (34.3) 44 (32.8)

SYNTAX score and in-hospital STEMI mortality

deceasedalive

Patie

nts

(N)

high low/mediumSYNTAX score

Clinical SYNTAX score and in-hospital STEMI mortality

deceasedalive

Patie

nts

(N)

high low/mediumclinical SYNTAX score

Receiver-operator characteristic (ROC) analysis

Tested score

AUC (95% CI) SE P

SYNTAX0.67 (0.58

- 0.74)0.0903 0.05

CSS0.84 (0.76

- 0.89)0.0719

0.0001

AUC diff. (95% CI)

0.170 (0.027-0.31)

0.073 0.01

sens

ibili

ty

100-specificity

ConclusionClinical SYNTAX score (including just 3 simple

clinical variables) is more efficient than the angiographic SYNTAX score in predicting the risk of in-hospital mortality after primary PCI for STEMI.

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