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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