Prognostic Utility of Culprit SYNTAX Score in Patients With Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction

Abstract

A higher SYNTAX score (SS) is strongly associated with poor prognosis in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (CS-STEMI). However, the predictive value of culprit-lesion SYNTAX score (cul-SS) and SS has not been compared although the culprit-lesion-only primary percutaneous coronary intervention (PCI) strategy showed improved long-term survival recently. This study compared the predictive utility of cul-SS and SS for in-hospital mortality among the patients with CS-STEMI from during 2010-2019. Of the 215 patients, 79 (37%) died. SS ≥22, cul-SS ≥11, final thrombolysis in myocardial infarction (TIMI) flow ≤2, and no-reflow phenomenon were associated with in-hospital mortality. In patients with multi-vessel disease, the nonsurvivors with cul-SS ≥11 had a higher mortality rate than the survivors (75.0% vs. 44.9%, p = 0.001), whereas the SS ≥22 showed no significant difference. The cul-SS ≥11 revealed only an independent factor in the multivariate analysis (OR 2.6, p = 0.010). the AUC of cul-SS ≥11 for in-hospital mortality was modest (0.617 p < 0.05), which might be augmented up to 0.745 (p < 0.001) by the combination with TIMI flow ≤2, no-reflow phenomenon, and blood total CO2 content <15 mEq/L. The cul-SS might be more predictive than SS for in-hospital mortality in our patients with CS-STEMI.