High SYNTAX Score Research Articles

RETRACTED ARTICLE: Association of severity of coronary artery disease by SYNTAX score (SS) and lower extremity arterial disease by duplex ultrasound (DUS) study\u2014an Indian perspective

BackgroundCoronary artery disease (CAD) and lower extremity artery disease (LEAD) often coexist. Ankle brachial index (ABI) has been shown to be an independent predictor of CAD. Studies have reported correlation of CAD and LEAD on the basis of ABI and also invasive angiography. But rigorous searching did not reveal any similar research where severity of LEAD was assessed by duplex ultrasound (DUS).In this study, we assessed the association of severity and localisation of LEAD by DUS with SYNTAX score (SS).ResultsA total of 637 subjects above 45 years of age with coronary angiographic confirmation of CAD were studied in this single centre cross-sectional, descriptive and analytical research. High SS was significantly more common in subjects with LEAD (p = 0.04). In the femoro-popliteal segment, total occlusion of arteries was found in significantly more proportion of subjects with high SS. A progressive increase in mean SS was noted across the grades of arterial disease in the femoro-popliteal segment (p = 0.007). 85.2% of the LEAD was in the femoro-popliteal segment, while below-knee arterial disease was present in 98.5% of subjects with LEAD. Hypertension, smoking, history of CVE and presentation with ACS independently increased the risk of LEAD.ConclusionHigh prevalence of asymptomatic LEAD and association of high SS with LEAD as a whole as well as femoro-popliteal involvement suggests the need for a point of care DUS study (POCUS) since treatment varies with location and extent of disease which cannot be fathomed by ABI alone. Being the largest study on association of CAD and LEAD from Indian subcontinent till date and also the first study to use non-invasive tool as DUS for LEAD assessment while studying its association with CAD makes this a landmark experience.

Glucose Triglycerides Index as a Predictor of Severity of Coronary Artery Assessed with Syntax Score I in Acute Coronary Syndrome Patients

Background: Pre-diabetes is a golden period to prevent and delay the development of diabetes. In coronary heart disease, there are more patients with impaired glucose tolerance than the patients without impaired glucose tolerance, so screening is needed in patients who have risk factors for cardiovascular disease. Assessment of insulin resistance is a "fundamental goal" that has a large value of prevention. Triglyceride Glucose (TyG) index is a surrogate marker of insulin resistance that can be applied to the community as a practical and efficient screening method.
 Aim: The purpose of this study was to assess TyG index for the severity of coronary arteries as assessed by SYNTAX score I in ACS patients.
 Methods: This study was an analytic cross-sectional study with a sample of 36 ACS patients who underwent coronary angiography (CAG) examinations in the catheterization laboratory of General Hospital Dr. Moewardi. The mean value of coronary artery severity was assessed using SYNTAX Score I. Subjects were then divided into two groups and then associated TyG index with coronary artery severity assessed by SYNTAX score I. A p value <0.05 was considered statistically significant.
 Results: In this study, the best TyG index value in predicting the severity of coronary arteries is a cut-off value of 8.67 (AUC 0.738) with a specificity of 70.00% and sensitivity of 69.23%. Multivariate logistic regression analysis showed that TyG index was an independent predictor of a high SYNTAX scores (OR 5.25, 95% CI 1.07 - 25.70).
 Conclusion: The TyG index shows good sensitivity and specificity to classify the degree of coronary severity in ACS patients with pre-diabetes.

Predictors for adverse outcomes of patients with recanalized chronic total occlusion lesion.

It is ill-defined which factors affect the prognosis of patients with recanalized chronic total occlusion (CTO). This study sought to investigate predictors for adverse outcome in such a cohort with long-time follow-up. From 2010 to 2013, patients with successfully recanalized CTO were included. The primary endpoint was a composite of all-cause death, myocardial infarction or target vessel revascularization (TVR). The secondary endpoints were TVR and target lesion revascularization (TLR). A total of 1987 patients were enrolled and 1806 (90.6%) subjects completed 5-year follow-up. Multivariate Cox analysis revealed that age≥75years (HR,1.70; 95% CI, 1.09-2.64; P=.02), left ventricular ejection fraction <40% (HR, 1.94; 95% CI, 1.02-3.69; P=.04) and residual SYNTAX score (HR, 1.02; 95% CI, 1.01-1.04; P=.01) were predictors for the primary endpoint. Non-LAD CTO (HR, 1.82; 95% CI, 1.23-2.70; P<.01), J-CTO score (HR, 1.31; 95% CI, 1.11-1.54; P<.01) and residual SYNTAX score (HR, 1.02; 95% CI, 1.00-1.04; P=.04) were independently related to TVR. Non-LAD CTO, high J-CTO score and residual SYNTAX score was also correlated with TLR. Advanced age, left ventricular dysfunction and residual SYNTAX score were predictors for composite cardiovascular events in patients with CTO after revascularization. Those with non-LAD CTO, high J-CTO and residual SYNTAX score had higher risk for revascularization.

Atherogenic Index of Plasma Is an Independent Risk Factor for Coronary Artery Disease and a Higher SYNTAX Score.

We aimed to identify the best diagnostic cutoff value of the atherogenic index of plasma (AIP) for coronary artery disease (CAD) and its correlation with the SYNTAX score (SS). From January 2016 to December 2019, 2253 patients with CAD and 1347 non-CAD patients with complete data were included in the study. Coronary angiography was performed using the Judkins technique, and the SS was calculated using network software. There were differences in age, body mass index, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol levels, and AIP between groups (all P < .01). Multivariate logistic regression analysis showed that AIP was an independent risk factor for CAD and a high SS (SS ≥ 23) with adjusted odds ratios of 2.248 (95% CI: 1.666-3.032, P < .01) and 1.623 (95% CI: 1.118-2.358, P < .01) per standard deviation increase. Receiver operating characteristic curve analysis revealed that the best diagnostic cutoff value of AIP for the prediction of CAD and SS ≥ 23 was 2.035 and 2.23, the specificity was 61.8% and 65.7%, the sensitivity was 76.4% and 54.9%, the Youden index was 0.382 and 0.206, and the area under the curve was 0.733 (95% CI: 0.717-0.750, P < .01) and 0.653 (95% CI: 0.630-0.676, P < .01). Atherogenic index of plasma, as a biomarker, may assist in the prevention of CAD in the Chinese population.

Serum amyloid A1 can be a novel biomarker for evaluating the presence and severity of acute coronary syndrome

BackgroundSerum amyloid A (SAA) is an acute phase protein and a novel inflammatory biomarker of cardiovascular diseases. Of the four subtypes, SAA1 is the most representative biomarker. In this study, we aimed to assess the value of SAA1 as a novel biomarker for evaluating the presence and severity of acute coronary syndrome (ACS) in Chinese patients. Methods and resultsA total of 140 ACS patients and 88 non-ACS patients (including 36 stable coronary artery disease (SCAD) patients and 52 healthy controls) who underwent coronary angiography were enrolled. The SAA1 level was significantly higher in ACS patients compared with the SCAD and healthy control subgroups (P < 0.001, respectively), and was significantly higher in the high SYNTAX Score II (SS II) group compared with the medium SS II group and low SS II group (P < 0.001, respectively) in ACS patients. The cutoff level of SAA1 for indicating the presence of ACS was 324.65 ng/mL (sensitivity of 77.9%, specificity of 60.2% and an area under the curve of 0.717). The increased SAA1 levels were positively associated with the presence (OR = 1.013, P < 0.001) and severity (OR = 1.023, P < 0.001) of ACS. Furthermore, there was a positive correlation between SAA1 levels and SS II (r = 0.467, P < 0.001). ConclusionsOur results suggest that elevated SAA1 levels may be a novel biomarker for evaluating the presence of ACS and the severity of CAD in ACS patients. Measuring SAA1 levels makes it possible to evaluate the presence of ACS and severity of CAD in ACS patients.

The relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction

Background The Synergy between Percutaneous Coronary Intervention (SYNTAX) score, has been used to estimate the extent and complexity of coronary artery disease (CAD). The H2FPEF score enables robust discrimination of heart failure with preserved ejection fraction (HFpEF) from non-cardiac aetiologies of dyspnea. In the present study, we aimed to investigate the relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction (NSTEMI). Method Two hundred eighty two consecutive patients with NSTEMI who underwent coronary angiographic examination were enrolled in this study. The H2FPEF score was calculated for each patient on admission. All patients underwent coronary angiography within 2 days following their admission. The SYNTAX scoring system was used to evaluate the severity and extent of CAD. Results The mean H2FPEF Score [3(2–4) vs 1(0.5–1.5), p < .001] and the frequencies of diabetes mellitus, hypertension and, atrial fibrillation were significantly higher and LVEF was significantly lower in patients with high SYNTAX score. High H2FPEF Score (OR: 3.61, 95%CI: 2.64–4.93; p = .001) and low left ventricular ejection fraction (OR: 0.94, 95%CI: 0.89–0.98; p = .013) were found to be independent associates for high SYNTAX score. H2FPEF Score above a cut-off level of 2.5 predicted high SYNTAX score with a sensitivity of 80% and a specificity of 82.5% (AUC: 0.890; 95%CI: 0.848–0.931; p < .001). There was a significant and moderate positive correlation between H2FPEF and SYNTAX Scores (r = 0.694, p < .001). Conclusion High H2FPEF score may be associated with high SYNTAX score and may be used to estimate the extent and complexity of CAD in NSTEMI patients.

Five-year outcomes comparing percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in patients with left main coronary artery disease: A systematic review and meta-analysis

Background and aimsIn patients with left main coronary artery disease (LMCAD), long-term outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) remain controversial. We conducted a meta-analysis to compare the efficacy and safety of PCI with DES and CABG in LMCAD patients. MethodsWe comprehensively searched in Web of Science, EMBASE, PubMed, and Cochrane databases for eligible randomised controlled trials (RCTs) comparing the 5-year clinical outcomes between PCI with DES and CABG in LMCAD patients. Random-effect models were applied to analyse risk ratios (RRs) and hazard ratios (HRs) across studies, and I2 to assess heterogeneity. ResultsWe screened 4 RCTs including 4394 patients distributed randomly into PCI (n = 2197) and CABG (n = 2197) groups. In comparison to CABG, PCI showed non-inferiority concerning a composite of death, myocardial infarction, and stroke (HR 1.22, 95% confident interval [CI] 0.84–1.75), death (HR 1.06, 95% CI 0.81–1.40) and stroke (HR 0.80, 95% CI 0.42–1.53). Regarding major adverse cardiac or cerebrovascular events (MACCE) rate, both strategies show clinical equipoise in patients with a low-to-intermediate Synergy Between PCI with TAXUS and Cardiac Surgery (SYNTAX) score (HR 1.20, 95% CI 0.85–1.70), while CABG had an advantage over PCI in those with a high SYNTAX score (HR 1.64, 95% CI 1.20–2.24). ConclusionsCABG showed advantage over PCI with DES for LMCAD patients in MACCE. PCI and CABG showed equivalent 5-year clinical risk of a composite of all-cause mortality, myocardial infarction, and stroke, but the former had higher risk of repeat revascularization.

The Value of 3-dimensional Speckle Tracking Echocardiography in the Diagnosis and Evaluation of Coronary Lesions in Stable Angina Pectoris Patients

Background: Echocardiography is the leading and feasible cardiac imaging in patients with cardiac disease. An early evaluation of patients with complex coronary lesions plays an important role in the prognosis and selection of treatment strategy. Objectives: To compare and determine the value of 3D speckle tracking echocardiography (3D SE) at rest in diagnosis of coronary artery disease (CAD) in stable angina pectoris patients using SYNTAX score as a reference. Patients and methods: A total of 90 patients with stable angina underwent invasive coronary angiography (CAG) enrolled into study from Islamic Cardiac Center at Al-Azhar University during the period from April 2017 to December 2019 and classified to case and control groups based on CAG results. Subjects underwent CAG and 3D-STE examination and SYNTAX score calculation, and then the patients were sub grouped according to SYNTAX score. Results: There was a significant difference in strain measurement (Global longitudinal, circumferential and radial strain) between SYNTAX score sub-groups. The absolute value of different strain measurements decreased from low SYNTAX score to intermediate or high SYNTAX scores. For GLS was -14.8±1.9%,-11.08±1.7 and -7.4 ±1.2, respectively, and for GAS was -39.5±1.08,-25.95±7.09 and -14.6±1.86, respectively, and for GCS was -24.47±3.89,-14.96±2.41 and -8.73± 2.53, respectively, using ROC curve analysis the cut off value of GLS that differentiate between high SYNTAX score (≥33) and non-high score (≤32) was -7.7 and -17.1 for GAS and -12.5 for GCS. The cut off value of GLS that differentiate between low SYNTAX score (≤22) and non-low score (≥23) was-12.5. Conclusion: Three-dimensional -STE is a noninvasive, reproducible, and efficient tool that has a potential clinical practice to evaluate the coronary lesion in chronic coronary syndrome patients. The absolute values of stain parameters were significantly associated with the complexity of coronary artery lesions.

Effect of High Homocysteine Level on the Severity of Coronary Heart Disease and Prognosis After Stent Implantation.

To determine the effect of high homocysteine (HCY) levels on the severity of coronary artery disease and prognosis after stent implantation. A prospective study was conducted on 667 patients with coronary heart disease who underwent drug-eluting stent implantation for the first time at the Department of Cardiology, Huludao Central Hospital, from January 2015 to December 2017. The patients were divided into the control and hyperhomocysteinemia (H-HCY) groups based on the serum HCY levels. The demographic and clinical characteristics of both groups were compared. In addition, the patients were followed up for 1 year to compare the incidence of major adverse cardiovascular and cerebrovascular events (MACCE). Multivariate logistic regression was used to determine the correlation between serum HCY levels and MACCE. Compared with the control group, the stenosis degree was significantly higher among patients in the H-Hcy group, as indicated by more coronary artery lesions (P < 0.001) and higher SYNTAX scores (P < 0.001). After 1 year of follow-up, the incidence of MACCE was also significantly higher in the H-HCY versus control group (9.5% vs. 15.1%; P = 0.042). Furthermore, age, history of diabetes, discontinuation of antiplatelet aggregation drugs, and HCY levels were independent predictors of MACCE. High HCY level is associated with severe coronary artery disease in patients with coronary heart disease and is an independent predictor of MACCE after stent implantation.

Frontal QRS-T angle predicts syntax score in patients with non-ST elevation myocardial infarction

BackgroundEarly risk stratification based on SYNTAX score plays a crucial role to identify the need for early invasive strategy in patients with NSTEMI. The predictive role of frontal QRS-T angle [f(QRS-T)] on the atherosclerotic burden of CAD is less clear in NSTEMI patients. In this study, we aimed to investigate the relationship between f(QRS-T) and SYNTAX score in NSTEMI patients. MethodsA total of consecutive 269 patients with the diagnosis of NSTEMI transferred to coronary care unit were included in the study. f(QRS-T) was calculated as the absolute value of the difference between the frontal plane QRS and T axes based on automatic report of ECG machine. Syntax score was computed using an online SYNTAX score calculator by well-experienced two cardiologists blinded to the study data. The study population was divided into two groups based on the SYNTAX score low SYNTAX score (≤23), and high SYNTAX score (>23). ResultsLeft ventricle ejection fraction (LVEF) (p = 0.001), hemoglobin (p = 0.03) and HDL-C (p = 0.04) levels were lower in the intermediate-high SYNTAX group. Age (72.1 ± 12.5 vs. 64.6 ± 9.4 respectively; p < 0.001), LAD as infarct-related artery 30 (%65.2) vs. 50 (%29.1) respectively; (p = 0.001), f(QRS-T) (100.5 ± 55.3 vs. 65.1 ± 53.1 respectively p = 0.006), troponin I peak (p = 0.06) were higher among patients with intermediate-high Syntax score. In receiver-operating characteristic (ROC) curve analysis, the value for f(QRS-T) to detect syntax score ≥ 23 with a sensitivity of 77% and specificity of 63% was 73,5° in NSTEMI patients(AUC = 0.69). Univariate logistic regression analysis identified that age, LVEF, HDL-C, hemoglobin, infarct-related artery, f(QRS-T) were significantly associated with SYNTAX score. Multivariate logistic regression analysis showed that age (OR: 1.135, 95% CI: 1.039–1.153, p = 0.045), infarct related artery-LAD (OR: 2.897, 95% CI: 1.023–8.209, p = 0.001) and f(QRS-T) (OR: 3.587, 95% CI: 1.093–11.772, p = 0.001) were the independent predictors of SYNTAX score. ConclusionIn NSTEMI patients, f(QRS-T) has been found to be a useful decision-making tool to predict SYNTAX score to assess early invasive strategy.

Long-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery according to the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score.

Percutaneous coronary intervention (PCI) of unprotected left-main coronary artery (uLMCA) is increasingly performed. Although it is recommended to calculate the SYNTAX score, if uLMCA PCI is considered, data of outcomes by the SYNTAX score are scarce, particularly among patients with high score (SYNTAX ≥ 33). To evaluate long-term outcomes of uLMCA PCI according to SYNTAX score in real-world practice. Patients following PCI of uLMCA throughout 2006-2018, in a tertiary hospital, were included and classified into three groups according to the SYNTAX I score. The primary outcome was three-year major adverse cardiac event (MACE) comprising all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), or coronary artery bypass surgery (CABG). Overall 632 patients were analyzed, mean age 72.8 ± 11.5, males: 69%, classified as following: SYNTAX <22 (n = 225); SYNTAX 22-32 (n = 250) and SYNTAX ≥33 (n = 157). Patients with greater SYNTAX score had higher prevalence of diabetes mellitus, renal failure, peripheral arterial disease and stroke. Additionally, they had lower ejection fraction, greater EuroScore, and number of vessels involved. Procedural success rates were very high (>95%) and did not depend on the SYNTAX score. The rates of MACE and its components were significantly higher in patients with higher SYNTAX score. Multivariate analysis showed that SYNTAX score is an independent predictor of three-year MACE following uLMCA PCI [HRSYNTAX22-32 = 3 (95% confidence interval [CI]: 1.2-11.5), HRSYNTAX≥33 = 3.4 (95% CI: 1.8-13.3]. Despite the high success rates of uLMCA PCI in real-world patients with high SYNTAX score, the latter was significantly associated with worse three-year outcomes.

Correlation between global longitudinal strain and SYNTAX score in coronary artery disease evaluation

BackgroundSpeckle tracking echocardiography may allow the evaluation of myocardial systolic and diastolic dynamics across different physiologic and pathologic conditions beyond traditional echocardiographic techniques. The use of STE longitudinal strain in identification and risk stratification of CAD has good reproducibility and accuracy. The study aims to detect the relationship between SYNTAX score and global longitudinal peak systolic strain (GLPSS) in patients undergoing coronary angiography, with no history of myocardial infarction.ResultsThe study included 70 symptomatic patients suspected to have chronic coronary syndrome aging 20–80 years (excluding those with significant structural heart disease). All patients underwent clinical evaluation, surface ECG, laboratory assessment, transthoracic echocardiographic (TTE), color TDI tracings, two-dimensional speckle tracking, and conventional coronary angiography with SYNTAX score calculation. Patients were divided into 3 groups based on the results of the coronary angiogram: normal CAD on angiogram (n = 10, control group), low SS (n = 25, SS < 22), and high SS (n = 35, SS ≥ 22).The mean age was 55 ± 9.6 years; 54% were males; two third of patients were hypertensive; 52% were diabetic; high percentage of high syntax score were noticed among males, diabetic patients, and smokers; and also low mean of GLS was noticed among diabetic patients and smokers. There was a statistically significant positive correlation between syntax score and each of LVEDD and LVESD and, on the other hand, statistically significant negative correlation between syntax score and each of E/A, GLS, AP2LS, AP3LS, and AP4LS was noticed. Peak GLS cutoff value of 17.8 and 16.5 showed 84% and 93% sensitivity and 70% and 91% specificity to detect high and low syntax score, respectively.Conclusion2D longitudinal strain analysis has incremental diagnostic value over visual assessment during echocardiography in predicting significant coronary artery disease; GLS may offer a potential sensitive tool to detect significant CAD.

Percutaneous vs. surgical revascularization for patients with unprotected left main stenosis: a meta-analysis of 5-year follow-up randomized controlled trials.

A 5-year survival of patients with unprotected left main (ULM) stenosis according to the choice of revascularization (percutaneous vs. surgical) remains to be defined. Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG) with a follow-up of at least 5 years were included. All-cause death was the primary endpoint. MACCE [a composite endpoint of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization] along with its single components and cardiovascular (CV) death were the secondary ones. Analyses were stratified according to the use of first- vs. last-generation coronary stents. Subgroup comparisons were performed according to SYNTAX score (below or above 33) and to age (using cut-offs of each trial's subgroup analysis). Four RCTs with 4394 patients were identified: 2197 were treated with CABG, 657 with first generation, and 1540 with last-generation stents. At 5-year rates of all-cause death did not differ [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.71-1.21], as those of CV death and stroke. Coronary artery bypass graft reduced rates of MACCE (OR 0.69, 95% CI 0.60-0.79), mainly driven by MI (OR 0.48, 95% CI 0.36-0.65) and revascularization (OR 0.53, 95% CI 0.45-0.64). Benefit of CABG for MACCE was consistent, although with different extent, across values of SYNTAX score (OR 0.76, 95% CI 0.59-0.97 for values < 32 and OR 0.63, 95% CI 0.47-0.84 for values ≥ 33) while was not evident for 'younger' patients (OR 0.83, 95% CI 0.65-1.07 vs. OR 0.65, 95% CI 0.51-0.84 for 'older' patients). For patients with ULM disease followed-up for 5 years, no significant difference was observed in all-cause and cardiovascular death between PCI and CABG. Coronary artery bypass graft reduced risk of MI, revascularization, and MACCE especially in older patients and in those with complex coronary disease and a high SYNTAX score.

Prognostic Value of SYNTAX Score in Patients With Infarct-Related Cardiogenic Shock: Insights From the CULPRIT-SHOCK Trial

ObjectivesThis study sought to evaluate the prognostic value of the SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) scores in patients undergoing percutaneous coronary intervention (PCI) for multivessel coronary disease with infarct-related cardiogenic shock (CS). BackgroundThe prognostic value of the SYNTAX score in this high-risk setting remains unclear. MethodsThe CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) trial was an international, open-label trial, where patients presenting with infarct-related CS and multivessel disease were randomized to a culprit-lesion-only or an immediate multivessel PCI strategy. Baseline SYNTAX score was assessed by a central core laboratory and categorized as low SYNTAX score (SS ≤22), intermediate SYNTAX score (22<SS≤32) and high SYNTAX score (SS>32). Adjudicated endpoints of interest were the 30-day risk of death or renal replacement therapy (RRT) and 1-year death. Associations between baseline SYNTAX score and outcomes were assessed using multivariate logistic regression. ResultsPre-PCI SYNTAX score was available in 624 patients, of whom 263 (42.1%), 207 (33.2%) and 154 (24.7%) presented with low, intermediate and high SYNTAX score, respectively. A stepwise increase in the incidence of adverse events was observed from low to intermediate and high SYNTAX score for the 30-day risk of death or RRT and the 1-year risk of death (p < 0.001, for all). After multiple adjustments, intermediate and high SYNTAX score remained strongly associated with 30-day risk of death or renal replacement therapy and 1-year risk of all-cause death. There was no significant interaction between SYNTAX score and the coronary revascularization strategy for any outcomes. ConclusionsIn patients presenting with multivessel disease and infarct-related CS, the SYNTAX score was strongly associated with 30-day death or RRT and 1-year mortality.

Ear Crease Features Are Associated with Complexity of Coronary Lesions.

BackgroundThe presence of a Frank’s sign ear crease is closely correlated with coronary artery disease (CAD). The SYNTAX score indicates the complexity of coronary lesions. This present investigation sought to identify the correlation between SYNTAX score and several specific ear creases.Material/MethodsFour specific types of ear creases – crossing crease not originated from ear hole (CC-NEH), crossing crease originated from ear hole (CC-EH), vertical creases on the face side (VC-F), and vertical creases dividing earlobe and face (VC-EF) – were investigated in patients undergoing coronary angiography. A Frank’s sign score system was introduced based on the 4 creases. Demographic data, clinical data, and SYNTAX score were also documented. The association between ear creases and SYNTAX score, as well as the correlation between Frank’s score and SYNTAX score, were statistically analyzed.ResultsCC-NEH had the highest positive predictive value (positive predictive value=0.439), and VC-F had the highest negative predictive value for the detection of intermediate and high SYNTAX score (negative predictive value=1.000). VC-EF and CC-NEH were associated with intermediate and high SYNTAX scores (OR=2.913–7.694, all P<0.05). Only 2.9% of patients with Frank’s score=0 had intermediate or high SYNTAX scores, and 52.2% and 50.0% of patients with Frank’s sign score=3 and 4 had intermediate or high SYNTAX scores, respectively. The Frank’s sign score was significantly and positively correlated with SYNTAX score (r=0.457, P<0.001).ConclusionsFeatures of specific ear creases and Frank’s sign scores were associated with intermediate and high complexity of coronary lesions.

The association between the fibrinogen-to-albumin ratio and coronary artery disease severity in patients with stable coronary artery disease.

Fibrinogen-to-albumin ratio (FAR) is an inexpensive and easily measurable novel inflammatory index that has been found to be associated with atherosclerosis. In this study, we aimed to investigate the association between the FAR and coronary artery disease (CAD) severity in patients with stable CAD. In total, 356 consecutive patients with CAD were classified into three groups, those with a low Synergy between percutaneous coronary intervention and the Taxus and Cardiac Surgery Study (SYNTAX) score (≤22), those with an intermediate SYNTAX score (23≥ SYNTAX score ≤32) and those with a high SYNTAX score (>32). We determined that there were significant differences in the mean age (P < 0.001), male gender (P = 0.008), serum fibrinogen (P = 0.03), low-density lipoprotein cholesterol (P < 0.001) and FAR (P < 0.001) among the SYNTAX score groups. A strong positive correlation was detected between FAR and SYNTAX score (r = 0.899; P < 0.001), and the cutoff level of FAR for high SYNTAX score was 82 (sensitivity of 82%, specificity of 88.3% and an area under the curve of 0.826). The novel inflammatory index, FAR, is significantly associated with the severity of CAD in patients with stable CAD.

Prognostic Significance of the Residual SYNTAX Score and Ischemic Reduction Detected with Nuclear Cardiology for Prediction of Major Cardiac Events after Revascularization.

Objective There is no report on the risk stratification of major cardiac events (MCEs) with a combination of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score and ischemic reduction detected with rest 201Tl and stress 99mTc-tetrofosmin myocardial perfusion single-photon-emission computed tomography (SPECT) after revascularization in Japanese patients with coronary artery disease (CAD). Methods This was a retrospective study. The patients were followed up to confirm their prognosis for at least one year. Ischemia was evaluated based on the summed difference scores converted to the percentage of the total myocardium Safety Data Sheet (SDS%). The SYNTAX score and SDS% were calculated before and after revascularization. The endpoint was the occurrence of MCEs. Patients Study subjects were 293 patients who had a ≥75% stenotic lesion detected with coronary angiography following confirmation of ≥5% ischemia with SPECT, underwent revascularization, and thereafter received a re-evaluation with SPECT and coronary angiography. Results During the follow-up, 25 patients experienced MCEs of cardiac death (n=2), non-fatal myocardial infarction (n=3), and unstable angina pectoris (n=20). A receiver operating characteristic analysis indicated that the best cut-off values of the residual SYNTAX score and ΔSDS% were 12 and 5%, respectively, for the prediction of MCEs. The patients with a low residual SYNTAX score (<12) and high ΔSDS% (≥5%) had the best prognosis, while those with a high residual SYNTAX score (≥12) and low ΔSDS% (<5%) had the worst prognosis. Conclusion The combination of the residual SYNTAX score and ischemic reduction detected with nuclear cardiology is useful for predicting MCEs after revascularization.

The relationship between galectin-3 and SYNTAX Score I in patients with non-ST-segment elevation myocardial infarction.

The expression of galectin-3 has been found to be increased in human atherosclerotic lesions, suggesting a role in atherogenesis. However, there is a lack of data regarding an association between galectin-3 and the extent, severity, and complexity of coronary artery disease (CAD). The aim of this study was to investigate the relationship between galectin-3 and SYNTAX Score I in patients with non-ST-segment elevation myocardial infarction (NSTEMI). This study included a total of 95 consecutive patients who were diagnosed with NSTEMI and underwent coronary angiography. The baseline galectin-3 level of each patient was measured. The SYNTAX Score I of each patient was calculated using the online calculator (www.syntaxscore.com). The study population was divided into 2 groups: SYNTAX Score I ≤22 group (n=55) and SYNTAX Score I >22 group (n=40). The galectin-3 level was significantly higher in the SYNTAX Score I >22 group than in the SYNTAX Score I ≤22 group (22.1±8.3 ng/mL vs. 13.5±7.7 ng/mL; p<0.001). Forward stepwise logistic regression analysis demonstrated that galectin-3 (odds ratio [OR]: 1.195, 95% confidence interval [CI]: 1.097-1.302; p<0.001), left ventricular ejection fraction (OR: 0.941, 95% CI: 0.888-0.997; p=0.040), and platelet count (OR: 1.013, 95% CI: 1.003-1.024; p=0.014) were independently associated with intermediate and high SYNTAX scores. ROC analysis provided a cut-off value of 14.0 ng/mL for galectin-3 to predict an intermediate or high SYNTAX Score I with 75.0% sensitivity and 51.0% specificity (p<0.001). In patients with NSTEMI, galectin-3 was associated with the extent, severity, and complexity of CAD as assessed by the SYNTAX Score I.

The relation of frontal QRS-T angle with syntax score in patients with ST segment elevation myocardial infarction

Aim: Current data regarding the relation between the Frontal QRS-T (FQRST) angle and the atherosclerotic burden is limited. This study purposed to investigate the relation between FQRST angle and the Syntax (SX) score in subjects presenting with STEMI. Material and Methods: Forty-nine patients who were admitted to the coronary care unit of a tertiary-care hospital for acute STEMI and underwent successful revascularization of the infarct related artery were included in this retrospective analysis. FQRST angle, QTc, and T peak- T end (TpTe) intervals were obtained from the presenting electrocardiogram (ECG). ECG was repeated 30 minutes after revascularization. The SX score was calculated using dedicated software. The study population was then divided into 3 tertiles based on the SYNTAX trial results as follows: SX score ≤ 22 (Low SX score, n=34), SX score ≥ 23 and 33 (Intermediate SX score, n=8), and those with an SX score ≥ 33(High SX score, n=7).Results: Median FQRST angle of the subjects with an SX score ≥ 33 was significantly wider than those with an SX score 22 had a longer TpTe interval than those with an SX score ≤ 22 points. SX score was significantly correlated with the FQRST angle (r=0.691, p 0.001) and TpTe interval (r=0.579, p 0.001).Conclusion: FQRST angle obtained from the admission surface ECG of the subjects with acute STEMI might reflect the extent and severity of the CAD, as demonstrated by the SX score. Moreover, FQRST angle may be useful in determination of the success of the revascularization in STEMI subjects.

Clinical parameters and its association with coronary involvement in diabetic vs. non-diabetic cad patients with reference to syntax score

Abstact: Background: Cardiac involvement is one of the commonest causes of morbidity and mortality in patients with diabetes. It manifest as coronary artery disease. Definitive diagnosis, precise assessment of CAD requires invasive diagnostic modality like conventional coronary angiography and its anatomic severity can be judged by Syntax score. Aims and objectives: 1) Extent and severity of coronary artery disease with reference to Syntax score between diabetics Vs Non diabetics. 2) Correlation between fasting glucose, Glycated Hemoglobin (Hb A1c),TC/HDL-C ratio, BMI (body mass index) and severity of coronary artery disease. Materials and methodology: 200 patients (100 Diabetics and 100 Non diabetics) after meeting inclusion and exclusion criteria, admitted with symptoms of acute or chronic coronary syndrome, scheduled to undergo coronary angiogram were taken. Results: In our study duration of diabetes and severity of coronary artery disease was not correlating but as compared to non-diabetics,diabetics had higher syntax score, 23-32 30(30%) were diabetics, while 13(13%)were nondiabetics, and score>33 9, (9%) diabetics as compared to nondiabetic has 1%,p value<0.001. Diabetics have more numbers of TVD (Triple Vessel Disease) 52% as compared to nondiabetics 12%, p value<0.001. Diabetics had more numbers of Total occlusion of vessel (p=0.027), Calcification (p=0.003), Proximal vessel involvement, (p=0.000), CTO (chronic total occlusion), p=0.027 and diffusely disease vessels (p=0.000), as compared to nondiabetics. Biochemical parameters like FBS, HbA1c and clinical parameters like BMI and Hypertension were not correlating with severity of coronary artery disease. In controls age is highly correlated with severity of coronary artery disease with correlation coefficient of 0.363 (p value=0.0001) whereas in cases TC/HDL is highly correlated with severity of coronary artery disease with correlation coefficient of 0.205 (p value 0.041). Conclusion: Diabetics have more numbers of Total vessel occlusion, CTOs, Proximal vessel involvement, calcifications and diffuse CAD.TC/HDL is better parameter to predict severity of CAD.