Utility of logistic clinical SYNTAX score in prediction of in-hospital mortality in ST-elevation myocardial infarction patients undergoing emergent coronary artery bypass graft surgery.

Abstract

The logistic clinical SYNTAX score (log CSS) is a combined risk scoring system including clinical and anatomic parameters; it has been found to be effective for the prediction of mortality in patients with ST-elevation myocardial infarction (STEMI). Coronary artery bypass grafting (CABG) in the primary treatment of acute myocardial infarction is still debated. In the present study, we aimed to evaluate the utility of log CSS to stratify the risk of in-hospital mortality in acute STEMI patients undergoing emergent CABG for primary revascularization. In total, 88 consecutive patients with acute STEMI, who did not qualify for primary percutaneous coronary intervention and required emergent CABG were included in our study. Nine of 88 patients died during hospitalization. The study population was divided into two groups as in-hospital survivors and non-survivors. Log CSS and SYNTAX score (SS) were calculated for both groups and two groups were compared in terms of demographics, preoperative, intraoperative, postoperative characteristics, SS and log CSS. Log CSS was found to be an independent predictor of in-hospital mortality, log CSS > 10.5 had 89% sensitivity, 81% specificity (area under the curve: 0.927; 95% confidence interval: 0.855-0.993). Moreover, peak troponin level was an independent predictor of in-hospital mortality. Glucose level, cardiopulmonary resuscitation before operation, glomerular filtration rate, left ventricular ejection fraction, and Killip class were significantly associated with in-hospital mortality. Log CSS may improve the accuracy of risk assessment in patients who are undergoing emergent CABG for primary revascularization of STEMI.