HbA1C modified Clinical SYNTAX score as a prognostic tool in patients with diabetes mellitus and multi-vessel coronary artery disease treated with primary percutaneous coronary intervention

Abstract

Abstract Introduction Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. Aim The study was intended to estimate and compare the predictive clinical value of the modified SYNTAX score versus the predictive clinical value of the SYNTAX score to the one-year appearance of MACE after conducted PCI in patients with DM (with diagnosis longer than one year and multivessel disease) and acute coronary syndrome (ACS). Material and methods A prospective cross-section study was performed in patients with DM and ACS. In the PCI period the following risk factors where were recorded: 1) age and metabolic variables – glycosylated hemoglobin (HbA1c), total cholesterol, triglyceridemia; 2) endocrinological variables – DM therapy, tip of DM; 3) ACS modality; 4) radiological / anatomical variable – SYNTAX score and 5) clinical variables in modified ACEF score and clinical SYNTAX score. One-year MACE were recorded. Results From a total of 136 consecutive patients, 55 of them developed at least one MACE in one-year follow-up. Two highly predictable MACE risk indexes (MACERI) were constructed. The first risk index – MACERI (c statistic = 0.879) was defined by: SYNTAX score >21, modified ACEF >1.38, HbA1c ≥8 (%), triglyceridemia ≥2.3 (mmol / L) in patients on insulin therapy and ACS modality – unstable angina pectoris. MACERI has better predictive characteristics than SYNTAX score (c statistic = 0.798) as well as ACF score, but not in relation to clinical SYNTAX score (c statistic = 0.820). The second risk index – MACERI II (c statistic = 0.923), defined the same risk factors as MACERI, except HbA1c ≥8 (%),which additionally contains a risk factor – the presence of three-vessel disease. MACERI II had significantly better predictive characteristics than all mentioned scores, but also in relation to MACERI. Conclusions MACERI and MACERI II can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with them the effects of these factors measure multidimensionally at valid and accurate manner. Funding Acknowledgement Type of funding source: None