0434 SYNTAX score in diabetic patients in the acute phase of myocardial infarction

Abstract

The syntax score (SS) was developed in 2005 by the team of the Rotterdam Thorax Center to characterize the complexity of the coronary network by taking into account: 1 /the number of lesions and their impact on function, 2 /the location of the lesions, and 3 /theircomplexity. However, patients in this study had multivessel disease and stable angina. In patients with acute myocardial infarction (AMI), we aim to study thecharacteristics of the SS in diabetic patients and todetermine the predictive value of the SS as compared with the GRACE score for inhospital death. Our study analysed 1107 consecutive patients, including 873 non-diabetic patients and 234 diabetic patients, hospitalized for AMI in the intensive coronary care unit ofDijon from September 2011 to December 2012 and whohad undergone coronary angiography. The SYNTAX and GRACE scores were both calculated for each patient. Median SS was significantly higher in diabetic patients (11 (4–15) vs. 8(4–15), p<0.001) than in non-diabetic patients. In multivariable analysis, three predictive factors for a high SS were found: female (OR=0.62; 95% CI=[0.45–0.89], (p=0.005)); age (OR=1.03; 95% CI=[1.02–1.04], (p<0.001)) and HDL-C (OR=0.28; 95%CI= [0.11–0.72], (p=0.008)). In-hospital mortality increased significantly with increasing SS score quartiles (Q1: 2.9%, Q2: 2.2%, Q3: 4.0%, and Q4: 9.7%, p<0.001). SSscore was associated with inhospital mortality, even after adjustment for confounding factors (GRACE scoreand left ventricular ejection fraction). In acute MI, the SS score is a reliable tool as it provides objective information on the coronary network and is aprognostic factor in the short term. Nonetheless, furtherstudies are needed to understand the influence of risk factors such as diabetes or hyperglycemia on the initialand residual SS, and to assess the impact of SS onpharmacological and other revascularization strategies.