Abstract
Aims We investigated the prognostic significance of residual SYNTAX score (RSS) in patients undergoing PCI due to STEMI and relationship between RSS and in-hospital and long-term ischemic cardiac events. Methods Between June 2015 and December 2018, 538 patients who underwent primary PCI were evaluated for in-hospital events and 478 patients were evaluated for clinical events during follow-up. Primary and secondary endpoints for both in-hospital and follow-up periods were cardiac death and major adverse cardiac events (MACE). Results 538 patients were included the study. RSS values of 131 patients were 0, and RSS values of 407 patients were >0. The median value of the RSS > 0 group was 7. According to this value, the RSS > 0 group was divided into 2 groups as R-ICR (RSS < 7, N = 188) and ICR (RSS ≥ 7, n = 219). In the RSS ≥ 7 group, during in-hospital and follow-up period, both mortality and MACE rates were higher than the other two groups. Area under the curve (AUC) for RSS for in-hospital death was found to be higher than SS (p=0.035) but similar to Grace Score (GS) (p=0.651). For MACE, RSS was higher than SS (p=0.025) and higher than the GS (p=0.041). For follow-up cardiac mortality, the AUC of the RSS was found to be higher than SS (0.870/0.763, p=0.02) and GS (0.870/0.733, p=0.001). For MACE, the AUC of RSS was higher than SS (p=0.03) and GS (p=0.004). Conclusions High RSS values in STEMI patients are associated with increased risk of ischemic cardiac events. RSS may help determine revascularization and level of additional PCI to improve prognosis by reducing the risk of ischemic cardiac events after P-PCI.
Highlights
ST-elevation myocardial infarction (STEMI) is known as a life-threatening complication of coronary artery disease (CAD) and it is one of the leading causes of death all over the world
At the time of Primary percutaneous coronary intervention (P-PCI), 4065% of the patients exhibit one or more concomitant coronary lesions (i.e., multivessel disease (MVD)). e presence of narrowed coronaries other than those related to index ischemia in patients with STEMI is suggested as a feature associated with adverse clinical outcomes [2]. e presence of MVD is strongly associated with higher 30-day mortality, reinfarction ratio, reduced myocardial reperfusion success, and occurrence of major adverse cardiac events (MACE) at 1 year compared with single-vessel CAD [3, 4]
Categorical data were analyzed by Pearson chi-square. e Kruskal–Wallis test was used for comparison of non-parametric variables between groups and the Bonferroni–Dunn test was used as a post hoc test for significant cases while One-Way ANOVA with post hoc Tukey HSD test was used for parametric variables. e receiver operating characteristic (ROC) analysis was applied to evaluate the predictive performance of SS, residual SYNTAX score (RSS), and Grace Score (GS) for MACE and cardiac death and area under the curve (AUC), sensitivity, and specificity were calculated and reported with 95% confidence intervals. e optimal cutoff point of measurements was determined as the value of the maximum Youden index
Summary
Received 1 May 2020; Revised 16 September 2020; Accepted 14 October 2020; Published 29 October 2020. We investigated the prognostic significance of residual SYNTAX score (RSS) in patients undergoing PCI due to STEMI and relationship between RSS and in-hospital and long-term ischemic cardiac events. Primary and secondary endpoints for both in-hospital and follow-up periods were cardiac death and major adverse cardiac events (MACE). In the RSS ≥ 7 group, during in-hospital and followup period, both mortality and MACE rates were higher than the other two groups. For follow-up cardiac mortality, the AUC of the RSS was found to be higher than SS (0.870/0.763, p 0.02) and GS (0.870/0.733, p 0.001). For MACE, the AUC of RSS was higher than SS (p 0.03) and GS (p 0.004). High RSS values in STEMI patients are associated with increased risk of ischemic cardiac events. RSS may help determine revascularization and level of additional PCI to improve prognosis by reducing the risk of ischemic cardiac events after P-PCI
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