High SYNTAX Score Research Articles

Coronary Angiography Findings among Diabetics and Non Diabetics Presenting with Acute Coronary Syndrome: A Case-control Study

Introduction: Patients with type-2 diabetes are at high risk for many Cardiovascular Diseases (CVD) such as coronary artery disease, stroke, peripheral arterial disease, cardiomyopathy, and congestive heart failure. Aim: To evaluate the coronary angiography profile in diabetics and non diabetics presenting with Acute Coronary Syndrome (ACS) in a tertiary care hospital in eastern India. Materials and Methods: This case-control study comprised 200 patients (100 were diabetics and 100 were non diabetics) diagnosed with ACS based on Electrocardiography (ECG) and cardiac enzymes. Data about baseline demographic, clinical and angiographic characteristics were collected. Moreover, angiographic thrombus burden grade, Cohen and Rentrop grade for collateral circulation, and Synergy Between Percutaneous Coronary intervention with Taxus and Cardiac Surgery(SYNTAX) score were also reported. Results: The mean number of vessel involvement was significantly higher in diabetics as opposed to non diabetics (2.1% vs. 1.5%, p-value=0.001). Left main coronary artery disease (20% vs. 10%, p-value=0.0012), osteoproximal disease (36% vs. 20%; p-value=0.032), bi/trifurcation lesion (40% vs. 22%; p-value=0.032), diffuse disease (60% vs. 30%; p-value=0.012), chronic total occlusion (16% vs. 7%; p-value=0.008), coronary calcification (22% vs. 12%; p-value=0.04), and microvascular disease (10% vs. 4%; p-value=0.02) were significantly more frequent in diabetics compared to non diabetics. Even after thrombolysis, thrombus grade 4-5 was highly observed in diabetics than non diabetics (4% vs. 0%; p-value=0.001). Grade 3 collateral circulation was less frequently developed in diabetics than non diabetics (1% vs. 4%; p-value=0.001). High SYNTAX score was highly noticed among diabetics than non diabetics (36% vs 20%; p-value=0.03). Conclusion: Diabetics with ACS had more thrombus burden of higher grade along with lesser collaterals, and higher SYNTAX score.

Improvement of left ventricular function after percutaneous coronary intervention in patients with stable coronary artery disease and preserved ejection fraction: Impact of diabetes mellitus.

BackgroundMany patients with stable coronary artery disease (CAD) have no visual segmental wall motion abnormalities and a left ventricular (LV) ejection fraction (LVEF) ≥ 50% at rest despite significant coronary artery stenosis. Here, the aim was to determine the impact of percutaneous coronary intervention (PCI) on LV function assessed by enhanced echocardiography in patients with stable CAD with or without diabetes mellitus type 2 and a preserved LVEF.MethodsSixty-six consecutive patients with CAD and LVEF ≥ 50%, admitted to the hospital for planned coronary angiography, were prospectively assessed. PCI was performed for coronary artery stenosis > 70%. CAD extent was assessed using SYNTAX and EXTENT scores. To assess LV function, LVEF, global longitudinal strain (GLS), and LV peak systolic myocardial velocity (S′) were measured and Tei index was calculated before and 3 months after PCI.ResultsBefore PCI, LVEF, GLS, and Tei index were significantly worse in diabetic patients. LV functional indices improved significantly after PCI in all patients (p < 0.001). Multivariate linear regression analyses were performed to evaluate the impact of selected factors on LV function after PCI expressed as changes (Δ) of LVEF, GLS, S′, and Tei index. LV function improvement expressed as ΔGLS was associated only with SYNTAX score. Higher SYNTAX scores were related to greater GLS improvement (β = 0.003, 95% confidence interval: 0.0004–0.005; p = 0.02).ConclusionsPercutaneous coronary intervention significantly improved LV function in diabetic and non-diabetic CAD patients with preserved LVEF. Enhanced echocardiography allowed an assessment of subtle changes in LV function.

Low Serum Calcitonin Gene-Related Peptide Level is Associated with Severity of Coronary Stenosis.

To evaluate the relationship between the serum calcitonin gene-related peptide (CGRP) level and severity of coronary stenosis. A total of 233 eligible patients who underwent coronary angiography were divided into two groups: a control and a coronary heart disease (CHD) group. The angiographic severity of coronary stenosis was evaluated by SYNTAX and Gensini scores. The incidence of major adverse cardiovascular events within two years was collected. A negative correlation between serum CGRP levels and Gensini scores was observed in all patients (r=-0.352, p<0.001), the control group (r=-0.422, p<0.001) and the CHD group (r=-0.393, p<0.001). Serum CGRP levels were negatively associated with SYNTAX scores in the CHD group (r=-0.522, p<0.001). The area under the curve of CGRP for identifying high SYNTAX scores (>22) was 0.772 [95% confidence interval (CI): 0.673-0.870, p<0.001], and for identifying high Gensini scores was 0.744 (95% CI: 0.646-0.842, p<0.001). A CGRP concentration of 25.05 pg/ml was selected as the cutoff point. A low CGRP level (<25.05 pg/ml) was an independent predictor of severe coronary stenosis, a SYNTAX score >22 [odds ratio (OR) =5.819, 95% CI: 2.240-15.116; p<0.001] and a high Gensini score (>64) (OR=4.943, 95% CI: 2.020-12.095; p<0.001). The low CGRP group had a higher incidence of major adverse cardiovascular events within two years (11.1 vs. 3.1%, p=0.031). In coronary atherosclerosis patients without acute myocardial injury, serum CGRP levels were negatively associated with the severity of coronary stenosis.

Anatomical and clinical risk stratification tool for mortality risk assessment following revascularization for multivessel coronary artery disease

ObjectiveThis study aimed to assess the prognostic ability of SYNTAX score II in left main and/or 3-vessel disease patients undergoing revascularization either by coronary artery bypass grafting or percutaneous coronary intervention in a national registry. MethodsThis prospective registry included consecutive patients with multivessel disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography. Of the 1112 study patients, 368 patients (33%) had a low (<25), 372 (33%) had an intermediate (25-35) and 372 patients (33%) a high (≥35) SYNTAX score II. ResultsPatients with a high SYNTAX score II had higher 30-day mortality compared with those with an intermediate or low SYNTAX score II (2.8% vs 0.6% vs 0% respectively, P = .001). Each 1-unit increment in SYNTAX score II increased the odds for death at 30 days by 11% (95% CI, 1.02-1.22; P = .026). Six-year mortality was higher among patients with a high compared with an intermediate or low SYNTAX score II (34.9% vs 11% vs 3.8%; log-rank P < .001). By adding a SYNTAX score II to standard prognostic factors, we showed a significant improvement of 40.1% (P < .001) for predicting 6-year mortality. The area under the curve of the SYNTAX score II (continuous) yielded 0.79 (95% CI, 0.75-0.82) in predicting 6-year mortality. ConclusionsOur findings show that the admission SYNTAX score II is a powerful marker of short- and long-term mortality, and therefore may be used as a risk stratification tool in patients with multivessel coronary artery disease who are candidates for revascularization.

The analysis of in-hospital and long-term results of percutaneous coronary intervention supported by extracorporeal membrane oxygenation in patients with coronary artery disease

Aim. To analyze in-hospital and long-term (12 months) results of percutaneous coronary intervention (PCI) supported by extracorporeal membrane oxygenation (ECMO) in patients with stable coronary heart disease and multivessel coronary artery disease, and to justify the use of such approach in the treatment of this group of patients.Methods. The retrospective analysis included 13 patients with stable coronary artery and multivessel coronary disease. The mean SYNTAX score before the intervention was 31.4±10.8. Between 30 days and 12 months in the postoperative period, the frequency and type of the following major adverse cardiovascular events (MACE) was assessed: all-cause death, myocardial infarction, stroke, repeat revascularization. Twelve months after the event, the data on the frequency and type of adverse cardiovascular events were collected by means of telephone follow-up.Results. Coronary intervention supported by ECMO was performed in all patients. 8 (61.6%) patients required an open surgical approach for ECMO cannula insertion. Door to balloon time was 109.6±79.2 minutes. The mean duration of ECMO support was 101.7±45.4 minutes. Haemodynamic instability, abnormalities in pulmonary gas exchange and rhythm disturbances were not revealed during primary PCI, making it possible to wean off the ECMO post-PCI. The mean residual SYNTAX score was 9.3±11.8. BARC class ≥3 bleeding complications were observed in 6 of 13 patients. Long-term major adverse cardiovascular events with fatal outcomes occurred in 3 (23.1%) patients.Conclusion. Supporting high-risk PCI with ECMO in patients with stable coronary artery disease, multivessel coronary artery disease and low left ventricular ejection fraction made it possible to successfully perform the intervention in all patients. Nevertheless, the long-term (12 months) results show a high percentage of recurrent myocardial infarction, which can be associated with high residual SYNTAX score.

Interleukin-35 Levels in Patients with Stable Coronary Artery Disease.

ResumoFundamento Foi demonstrado que as subunidades de interleucina-35 (IL-35) estão fortemente expressas nas placas ateroscleróticas em humanos. Assim, considera-se que elas têm um papel na aterosclerose.Objetivos Neste estudo, os níveis de IL-35 foram comparados com o grupo controle em pacientes com doença arterial coronariana (DAC) estável, e a associação entre os níveis de IL-35 e o tipo, gravidade e extensão da lesão foram investigadas com o escore Gensini (GS) e o escore Syntax (SS) no grupo de pacientesMétodos Sessenta pacientes (18 mulheres e 42 homens) com DAC, diagnosticados por meio da angiografia coronária, que apresentaram dor no peito típica e teste de esforço não invasivo positivo, e 46 pacientes (18 mulheres e 28 homens) com luminograma normal, foram incluídos no estudo. Tanto o GS quanto o SS foram calculados para o grupo de pacientes, e esses valores foram comparados com os níveis de IL-35. Variáveis com distribuição não normal foram avaliadas com o teste U de Mann-Whitney, enquanto os parâmetros com distribuição normal foram analisados com o teste t de Student. A diferença entre as variáveis categóricas foi avaliada pelo teste de qui-quadrado ou de Fisher. Os valores de p<0,05 foram considerados como estatisticamente sinificativos.Resultados Não foram observadas diferenças significativas entre pacientes e o grupo controle em termos de características demográficas e achados laboratoriais. Em comparação ao grupo controle, os níveis de IL-35 no grupo com DAC foram consideravalmente menores (36,9±63,9 ng/ml vs. 33,2±13,2 ng/ml, p<0,008). Embora não tenha sido estatisticamente significativo, os níveis de IL-35 foram maiores em pacientes com SS mais baixo do que nos com SS mais alto (33,2±13,7 vs. 31,8±8,9, p=0,51). Os valores de IL-35 em pacientes com GS alto foram significativamente mais baixos do que em pacientes com GS baixo (35±17,4 vs. 30,7±8,6, p=0,043).Conclusão Demonstrou-se que os níveis de IL-35 podem ser um novo biomarcador para a DAC estável, e que a IL-35 está associada à extensão da DAC.

634 Long term prognostic effect of lipoprotein in patients with and without diabetes mellitus after myocardial infarction

Abstract Aims The aim is to describe the baseline clinical, laboratory, and angiographic characteristics of patients with acute myocardial infarction (MI) according to the presence or not of diabetes mellitus (DM), and to evaluate if DM may influence the effect of lipoproteina [Lpa] serum level on long-term outcome in this very high-risk population. Methods and results This was a retrospective, single-centre, study including consecutive patients admitted with MI diagnosis between 1 January 2017 and 31 December 2020. The availability of data on baseline Lpa serum level was considered as an inclusion criterion. The study population was divided into two groups according to the presence or not of DM. The Lpa value of 50 mg/dl was used to test the hypothesis of a different effect of Lpa on the clinical outcome of patients with or without DM. The primary study outcome was all-cause death at 3-year follow-up. The study population included 997 patients (mean age 63.7 ± 13.5 years; 75.7% were males). Diabetes was reported in 280 (28.1%) patients. DM patients were older than those without DM (67.8 ± 12.1 vs. 62.0 ± 13.7 years, P &amp;lt; 0.001) and showed a significantly higher prevalence of dyslipidaemia, hypertension, obesity, prior MI, and prior coronary revascularization (P &amp;lt; 0.001). DM patients showed higher SYNTAX score value (19.8 vs. 15.1, P &amp;lt; 0.001) and a higher prevalence of left main involvement (6.3 vs. 3.1, P = 0.023). At Kaplan–Meier analysis, in the group without DM, patients with Lpa ≥ 50 mg/dl showed a significantly lower long-term survival compared with those with Lpa &amp;lt; 50 mg/dl (Log-Rank = 0.004). In DM patients, conversely, no survival difference was found between patients with Lpa ≥ 50 mg/dl vs. those with Lpa &amp;lt; 50 mg/dl. At multivariable Cox regression analysis, in patients without DM, Lpa serum level (HR: 2.68, 95% CI: 1.23–5.83; P = 0.013) and age (HR: 1.06, 95% CI: 1.04–1.09; P &amp;lt; 0.001) were independent predictors of mortality at 3-year follow-up. Among DM patients, only age was independently associated with 3-year mortality (HR: 1.07, 95% CI: 1.03–1.10; P &amp;lt; 0.001) (Table). Conclusions In this MI population, Lpa was independently associated with long-term mortality in patients without DM, but not in patients with DM. Whether DM can modify the effect of Lpa on clinical outcome after MI requires confirmation by larger prospective studies.

The relationship between IL-6 levels and the angiographic severity of coronary artery disease following percutaneous coronary intervention in acute coronary syndrome patients

BackgroundThe present investigation was developed for the exploration of the association between IL-6 levels and acute coronary syndrome (ACS) findings upon angiographic evaluation.MethodsA retrospective review of 346 patients suffering from chest discomfort that underwent coronary angiography was performed. The SYNergy between Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score (SS) and SS II were used to gauge ACS severity, with ACS patients being stratified into two groups based on an SS value of 22 and the median SS II value. Associations between IL-6 levels and SS or SS II values were assessed through Spearman's correlation analyses, and independent predictors of intermediate-high SS or high SS II were identified via a multivariate logistic regression approach. A receiver operating characteristic (ROC) curve was employed to explore of the predictive value of IL-6 levels.ResultsIL-6 was positively correlated with both SS (r = 0.479, P < 0.001) and SS II (r = 0.305, P < 0.001). Moreover, IL-6 levels were independently predictive of intermediate-high SS and high SS II values. ROC curves further demonstrated that IL-6 was able to predict intermediate-high SS and high SS II, with area under the curve (AUC) values of 0.806 and 0.624, respectively.ConclusionIL-6 levels are closely linked to the extent of coronary artery disease in ACS patients undergoing percutaneous coronary intervention. IL-6 levels may thus serve as a valuable and non-invasive biomarker of high-risk ACS patients.

Tp-e/QTc ratio, SYNTAX, and GRACE score in patients who underwent coronary angiography owing to acute coronary syndrome.

Ventricular arrhythmias following acute coronary syndrome (ACS) range from benign to life-threatening fatal arrhythmias. Tpeak-end (Tp-e) interval has been shown to be an important parameter in the assessment of repolarization dispersion. We aimed to evaluate the relationship between SYNTAX and Global Registry of Acute Coronary Events (GRACE) risk score calculated on admission and Tp-e interval and Tp-e/QTc ratio. A total of 421 patients were included in the study. The patients were divided into 2 groups as low SYNTAX score (≤22) and moderate and high risk SYNTAX score (>22). According to the GRACE risk score, the patients were divided into 2 groups; high-risk patients ≥140 and <140 low-risk patients. In the group with SYNTAX score >22, the Tp-e interval (p<0.001) and Tp-e/QTc ratio (p<0.001) was found to be significantly higher than in the group with a SYNTAX score ≤22. Tp-e interval (p<0.001) and Tp-e/QTc ratio (p=0.002) was higher in patients with GRACE risk score ≥140 compared with patients with a GRACE risk score <140. The correlation between Tp-e interval and Tp-e/QTc ratio and SYNTAX score (r=0.489; p<0.001) and GRACE risk score (r=0.274; p<0.001) were found to be significant. A significant and independent correlation was found between the SYNTAX score and Tp-e/QTc ratio (β=0.385; p<0.001). Tp-e interval and Tp-e/QT ratio increased in patients with severe coronary artery disease assessed with SYNTAX score. Tp-e interval and Tp-e/QT ratio increased in patients with a high GRACE risk score.

Value of GRACE and SYNTAX scores for predicting the prognosis of patients with non-ST elevation acute coronary syndrome.

BACKGROUNDGRACE and SYNTAX scores are important tools to assess prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, there have been few studies on their value in patients receiving different types of therapies.AIMTo explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies. METHODSThe data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups. A total of 195 patients who received agents alone comprised the medication group, 156 who received medical therapy combined with stents comprised the stent group, and 35 patients who were given agents and underwent coronary artery bypass grafting (CABG) comprised the CABG group. General information was compared among the three groups. GRACE and SYNTAX scores were calculated. The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events (MACEs) was analyzed. Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS. Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model. RESULTSThe incidence of MACE increased with the elevation of GRACE and SYNTAX scores (all P < 0.05). The incidence of MACE was 18.5%, 36.5%, and 42.9% in the medication group, stent group, and CABG group, respectively. By comparison, the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups (all P < 0.05). The incidence of MACE was 6.2%, 28.0% and 40.0% in patients with a low GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 31.0%, 30.3% and 42.9% in patients with a medium GRACE score in the medication group, stent group, and CABG group, respectively (P > 0.05). The incidence of MACE was 16.9%, 46.2%, and 43.8% in patients with a high GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 16.2%, 35.4% and 60.0% in patients with a low SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 37.5%, 40.9%, and 41.7% in patients with a medium SYNTAX score in the medication group, stent group, and CABG group, respectively (P > 0.05). MACE incidence was 50.0%, 75.0%, and 25.0% in patients with a high SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). Univariate Cox regression analyses showed that both GRACE score (hazard ratio [HR] = 1.212, 95% confidence interval [CI]: 1.083 to 1.176; P < 0.05) and SYNTAX score (HR = 1.160, 95%CI: 1.104 to 1.192; P < 0.05) were factors influencing MACE (all P < 0.05). Multivariate Cox regression analyses showed that GRACE (HR = 1.091, 95%CI: 1.015 to 1.037; P < 0.05) and SYNTAX scores (HR = 1.031, 95%CI: 1.076 to 1.143; P < 0.05) were independent predictors of MACE (all P < 0.05). CONCLUSIONGRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients, and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.

Abstract 13808: Impact of Complex Percutaneous Coronary Intervention Features Among Patients With or Without Chronic Kidney Disease

Introduction: Among patients undergoing percutaneous coronary intervention (PCI), those with chronic kidney disease (CKD) sustain poor clinical outcomes. However, there is a paucity of data on the impact of complex PCI (CPCI) on long-term prognosis, according to the presence of CKD. Objective: To determine the prognostic impact of complex procedural features in patients undergoing PCI with and without CKD. Methods: Patients undergoing PCI at a tertiary-care center between 2012 and 2019 were stratified according to the presence of CKD and procedural complexity. A CPCI was defined by the presence of ≥1 of the following: stent length &gt;60 mm, ≥3 stents, ≥3 lesions, ≥3 target vessels, bifurcation with ≥2 stents, or chronic total occlusion. The primary outcome of interest was major adverse cardiac events (MACE), a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR) at 1 year. Results: Out of 15,071 patients, our study population consisted of 4,537 (30.1%) with CKD of whom 1,151 (25.4%) underwent CPCI, while 2,983 (28.3%) patients without CKD underwent a CPCI. The prevalence of traditional risk factors was similar among patients within the same group (CKD and no-CKD), irrespective of PCI complexity. Nonetheless, patients undergoing CPCI had more extensive coronary artery disease (i.e., higher syntax score, severe calcification, and longer lesion length). CPCI was associated with a higher risk of MACE at 1 year in both groups, though a greater risk was observed in those without concomitant CKD, mainly driven by a higher risk of MI and TVR (Figure 1). However, the risk of all-cause death was significantly higher among CKD patients undergoing a CPCI, and there was no significant difference between those with and without CPCI in non-CKD group. Conclusions: CPCI is associated with an increase in the risk of 1-year MACE among patients with or without CKD. The larger increase in the risk of MACE is observed in those without CKD, than those with CKD.

Abstract 12110: Low Density Lipoprotein Receptor-Related Protein 1 Levels and Syntax Score in Patients Presenting With ST Elevation Myocardial Infarction

Introduction: Low density lipoprotein receptor-related protein 1 (LRP1) protects against cardiomyocyte death through its ability to promote Akt- and ERK1/2-dependent survival pathways. LRP1 signaling is crucial in promoting cell survival. LRP1 inhibits cell death, and promotes the resolution of the inflammation and scar formation following tissue injury. LRP1 serves as a common receptor that mediates the myocardial cell protective effects of several signaling cascades. The association between LRP1 and severity coronary artery disease (CAD) in the setting of acute injury, such as ST elevation myocardial infarction (STEMI) remains to be elucidated. We measured the soluble LRP1 (sLRP1) levels in patients who presented with STEMI. CAD severity as assessed by SYNTAX score. Methods: We measured sLRP1 levels in 46 patients who presented with STEMI (mean age 61±13.3, M/F=36/10). The SYNTAX score was categorized as low (≤20), and high (&gt;20). The control group (n=60) was selected from outpatients without significant comorbidities (N=60, age 47±14.2, M/F=16/44). Results: Patients with STEMI and high SYNTAX scores display significantly lower sLRP1 levels compared to the group with STEMI and low syntax score and controls (p=0.035 and 0.016, respectively). Median (IQR) sLRP1 levels are 1.90 (0.67), 2.25 (2.56) and 2.26 (1.59) μg/ml, respectively (Figure 1). Conclusions: Previous studies indicate that LRP1 is cardioprotective by the activation of the reperfusion injury salvage kinase pathway after ischemia reperfusion. In this study we observe that sLRP1 decreases with the complexity of CAD in patients with STEMI. Low sLRP1 levels can be a biomarker of complex CAD. Various studies have reported the role of LRP1 in cardiac remodeling after myocardial injury. Future studies are required to estimate the utility of sLRP1 as a diagnostic and prognostic biomarker in STEMI. This work was supported by the Research Fund of Istanbul Medeniyet University (project number 1358).

Economic Impact And SafetY of Same-Day Discharge Following Percutaneous Coronary Intervention: A Tertiary-Care Centre Experience From Northern India (EASY-SDD)

BackgroundThe literature about the safety and feasibility of same-day discharge (SDD) following complex percutaneous coronary intervention (PCI) and in acute coronary syndrome (ACS) is scarce. The economic impact of SDD has not been evaluated in this geographical region. We in the present study evaluated the safety, feasibility, and economic impact of SDD following PCI at a tertiary care centre of north India. MethodsIt was a single-centre, non-randomized, prospective study, in which all consecutive PCI patients during the study period of 15 months were evaluated for SDD using a “patient-centred” approach. The patients who were discharged on the next calendar day were included in the next day discharge (NDD) group. The baseline demographic data including coronary risk factors, clinical presentation, and management details were noted for all patients. All patients were followed up for 6 weeks. The Indian health system is only partially insured, hence most of the expendable costs are borne by patients. In the present study, we computed the total societal expenditure of each PCI which includes both the health system costs and the expenditure borne by the patients. A standardized tool and bottoms up costing method were used for recording out-of-pocket expenditure (OOPE) by the patients and health care expenditure respectively. ResultsOut of a total of 675 PCI patients, 617 patients were enrolled in the study, and 132/617 (21.39%) patients were discharged the same day. Sixty-five % of patients (86/132) in the SDD cohort and 70% of patients (337/485) in the NDD cohort presented with ACS. Baseline characteristics in the two cohorts were identical. A higher syntax score, greater number of stents, and longer stented segment predicted the NDD. The mean length of stay after PCI in patients with SDD and NDD was 8.71 ± 2.48 and 21.76 ± 2.42 h, respectively. In the SDD group, there were no readmissions or adverse events after discharge till 6 weeks of follow-up. The total mean cost of PCI (health care system and OOPE) for SDD and NDD was Indian Rupees (INR) 129,322.14 [United States dollar (US$) 1810.51] and INR 165500.71 [US$ 2317.01] respectively. An amount of INR 36178.57 (health system cost: INR 10242.76 and OOPE: INR 25935.71 was saved for each SDD. Besides 100 cardiac unit bed days including 85 intensive cardiac care bed days were saved with 21% SDD in the present cohort. ConclusionPost PCI SDD is safe and feasible in selected ACS/chronic stable angina patients using the “patient-centred” approach. Besides, decreasing OOPE for the patients, SDD also helps in the efficient use of scarce health system resources.

Prognostic value of CHA2DS2-VASc score in predicting high SYNTAX score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation

To evaluate the prognostic value of preprocedural CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, previous stroke or transient ischemic attack (TIA) (doubled), vascular disease, age 65-74 years, female gender] score in predicting high SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score and in-hospital mortality for non-atrial fibrillation (AF) patients presenting with non-ST elevation myocardial infarction (NSTEMI). The CHA2DS2-VASc score used to determine thromboembolic risks in AF was recently reported to predict major adverse clinical outcomes in patients with the acute coronary syndrome, irrespective of AF. A total of 906 patients with a diagnosis of NSTEMI who underwent coronary angiography were retrospectively enrolled and divided into three groups according to their SYNTAX scores (low, intermediate, and high). The CHA2DS2-VASc score of each patient was calculated. SYNTAX score had a significant positive correlation with the CHA2DS2-VASc score (r=0.320; p<0.001) in the Spearman correlation analysis. The CHA2DS2-VASc score [Odds ratio, 1.445; 95% confidence interval (CI), 1.268-1.648, p<0.001], left ventricular ejection fraction, creatinine, C-reactive protein, and high-density and low-density lipoprotein cholesterol levels were demonstrated to be independent predictors of high SYNTAX score. The CHA2DS2-VASc score [Hazard ratio (HR), 1.867; 95% CI: 1.462-2.384; p<0.001], the SYNTAX score (HR, 1.049; p=0.003), and age (HR, 1.057; p=0.002) were independently associated with higher risk of in-hospital mortality in a multiple Cox-regression model. Kaplan-Meier survival curves stratified by the CHA2DS2-VASc score (<4 vs. ≥4) also showed that higher CHA2DS2-VASc scores were associated with higher in-hospital mortality. In non-AF patients with NSTEMI, CHA2DS2-VASc and SYNTAX scores are useful for prognosis assessment and can be used to identify patients at higher risk for in-hospital mortality.

Akut Anterior Miyokard İnfarktüsü Geçiren ve Primer Perkütan Koroner Girişim Uygulanan Hastalarda Sol Ventrikül Apikal Trombüs Oluşumunun Öngördürücüleri: SYNTAX Skorunun Önemi

Aim: Left ventricular (LV) apical thrombus development is one of the important advers event patients with anterior ST elevation myocardial infarction (STEMI) and accompanies with LV apical aneurysm and systolic dysfunction. SYNTAX score is an important determinant of cardiovascular morbidity and mortality in patients with coronary artery disease. We aimed that the relationship between LV apical thrombus and SYNTAX score and other clinical risk factors patients with anterior STEMI Methods: A total of 205 consecutive anterior STEMI patients undergoing primary PCI (35 female/ 170 male mean age: 55.8 ± 9.6 years) were included in our study. We assessed the severity and complexity of coronary artery disease by using SYNTAX score. The patients were divided into two groups; patients with apical thrombus (n=19) and patients without apical thrombus(n=186). Results: We found that systolic and diastolic blood pressure were lower patients with apical thrombus groups. (p&amp;lt;0.001 for both). Syntax score was higher and LV ejection fraction (LVEF) is lower in patients with apical thrombus (p&amp;lt;0.001 for both). We also showed that LV apical thrombus formation was independently associated with lower systolic blood pressure (p=0.006), SYNYAX score (p=0.003), and depressed LVEF (p=0.001). Conclusion: In this study, impaired LVEF, lower systolic blood pressure and SYNTAX score have been found to be predictors of LV thrombus generation. Patients presenting with anterior myocardial infarction who have high SYNTAX scores (&amp;gt; 18.25) at PPCI should be followed up closely.

TCT-375 High Syntax Score and Left Main Percutaneous Coronary Intervention in High-Risk Patients: Long-Term Follow-Up Real-World Experience of a Single Center Without On-Site Cardiac Surgery

TCT-375 High Syntax Score and Left Main Percutaneous Coronary Intervention in High-Risk Patients: Long-Term Follow-Up Real-World Experience of a Single Center Without On-Site Cardiac Surgery

The prognostic value of the basal SYNTAX score I after early percutaneous coronary intervention using second generation drug eluting stents in patients with ST elevation myocardial infarction

Abstract Introduction The SYNTAX score is an angiographic tool used to grade coronary artery disease (CAD) burden and complexity. SYNTAX score predicts 1-year adverse outcomes for patients with multivessel and/or left main CAD who undergo percutaneous coronary intervention (PCI). However, the relationship of the pre-PCI (basal) SYNTAX score to long-term outcomes of patients with ST-elevation myocardial infarction (STEMI) treated with primary PCI is unknown. Purpose To evaluate the short-term (in-hospital) and long-term (5-year) prognostic value of basal SYNTAX score in patients with STEMI who were treated with primary PCI. Methods We retrospectively reviewed records of consecutive patients presenting with STEMI, admitted from January 2014 to December 2016, who underwent primary PCI. We categorized patients into two groups according to SYNTAX scores: low/intermediate (≤22, 23–32) and high (&amp;gt;33). We utilized the Cochran-Armitage test for trend, Chi-square test, Fisher's Exact test, and Kruskal-Wallis tests to assess differences in baseline characteristics and outcomes as appropriate. We used logistic regression and calculated the area under the receiver operating characteristic curve to determine the prognostic ability of SYNTAX score groups on 5-year outcomes for stroke, myocardial infarction (MI), cardiovascular death, target vessel revascularization (TVR), all-cause mortality, and major adverse cardiovascular events (MACE). Results There were 768 patients who met inclusion criteria for this study. 559 (72.8%) patients were in the low/intermediate SYNTAX score group and 209 (27.2%) patients were in the high SYNTAX score group. Baseline characteristics did not differ significantly between the two groups. In-hospital pacemaker implantation, in-hospital stent thrombosis, and in-hospital cardiac arrest and in-hospital death were rare and did not differ according to SYNTAX group (Table 1). However, the odds of experiencing stroke, MI, cardiovascular death, TVR, all-cause mortality, and MACE at 5 years were significantly higher in the high SYNTAX score group, even when adjusted for heart failure, total cholesterol, and age. The associated areas under the receiver operating characteristic curve indicated moderate-to-strong prognostic ability of the basal SYNTAX score (Table 2). Conclusion A high SYNTAX score in patients with STEMI who undergo primary PCI is associated poorer long-term outcomes, compared to patients with an intermediate/low score. This work confirms that a high burden of CAD in patients with STEMI portends a poorer long-term prognosis. Funding Acknowledgement Type of funding sources: None.

Mid-term mortality after stenting of distal left main stenosis with regular, third generation drug eluting stent or dedicated bifurcation stent or surgery-registry based,all-comers data

Abstract Background Distal left main (LM) bifurcation lesions remain a challenge for interventional cardiologists and they are associated with significant morbidity and mortality. The aim of the current study was to identify predictors of cardiac mortality at mid-term follow up after PCI (DES vs. dedicated bifurcation stent) or CABG. Methods All patients with distal LM stenosis ≥50% were included in prospective registry starting from 01.2015. The exclusion criteria for registry are cardiogenic shock, a priory life expectancy duration &amp;lt;1 year, lack of inform consent. All patients were prospectively followed about the alive status through the national security number data base. All deaths were deemed cardiac if proof otherwise (the data patient families or family's physicians were contacted through phone call about the reason of death) Results For three year follow up period (median 35 months, IQR 18–50) 303 patients were included. 220 patients were stented with 3rd generation DES, 43 with dedicated bifurcation stent BiOSS (Balton, Poland), and rest were sent for CABG. The mean age was 67±10 years, 72% were males, 37% diabetics, all with hypertension, 97% dyslipidemia, 15% PAD, 9% COPD, 16% carotid artery disease, previous MI 28%, previous PCI 50% - without significant difference between three groups. The frequency of acute coronary syndrome during admission was 11% - without difference in frequency between groups. The patient referred to CABG had significantly lower left ventricular EDV and ESV, more severe mitral regurgitation and kinetic disturbances, higher SYNTAX score and longer lesion length. On univariate COX regression analysis, the following factors were associated with mortality: age, NYHA class, GFR, baseline troponin, hemoglobin, LV EF, mitral regurgitation, kinetics disturbances, treatment with beta blockers, ACE inhibitors, statin, atrial fibrillation, SYNTAX score, lesion length. The type of treatment was not associated with differences in mortality (figure). On COX multiple regression survival analysis independent predictors of survival were: age (HR=1.036, CI 1.005–1.068, p=0.023); COPD (HR=2.313, CI 1.170–4.572, p=0.016); GFR (HR=0.988, CI 0.978–1.000, p=0.048); hemoglobin (HR=0.970, CI 0.955–0.986, p=0.000); left ventricular EF (HR=0.958, CI 0.832–0.985, p=0.003). Conclusions The type of treatment was not associated with mid-term mortality. Our data demonstrate that dedicated bifurcation stent could be used safely for distal LM stenosis treatment with similar safety as 3rd generation DES. Funding Acknowledgement Type of funding sources: None.

Impact of diabetes on coronary severity and cardiovascular outcomes in patients with heterozygous familial hypercholesterolemia: an analysis of genotype and phenotype

Abstract Aims Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardiovascular disease. However, the association between T2DM and coronary artery disease (CAD) in patients with heterozygous familial hypercholesterolemia (HeFH) has not been thoroughly evaluated. Our study aimed to assess the effect of T2DM on CAD severity and hard cardiovascular endpoints in a HeFH cohort. Methods A total of 432 patients with HeFH with a molecular and/or clinical Dutch Lipid Clinic Network score ≥6 (definite and probable) were enrolled. Patients were divided into a T2DM group (n=99) and a non-T2DM group (n=333). Hard endpoints included a composite of non-fatal myocardial infarction, stroke, and cardiac death. Results No differences were observed regarding genetic mutations in patients with and without T2DM. Patients with T2DM demonstrated a greater number of diseased vessels (p=0.029) and more severe coronary lesions with high Gensini, SYNTAX, and Jeopardy score tertiles. Compared with patients without T2DM, patients with T2DM were at a significantly greater risk of hard endpoints (multivariate adjusted hazard ratio [HR] 2.32, 95% confidence interval [CI] 1.02–4.84, p=0.025). Additionally, patients with T2DM and good glucose control (HbA1c &amp;lt;7.0%) were at a lower risk of hard endpoints compared with those with poor glucose control (HbA1c ≥7.0%, HR 0.08, 95% CI 0.01–0.56, p=0.011). Conclusions We conclude that T2DM is an independent predictor of CAD severity when assessed by four different tests and worse cardiovascular outcomes, suggesting that T2DM could be further used for risk stratification of patients with HeFH. Funding Acknowledgement Type of funding sources: None. Graphical abstract

Association between plasma big endothelin-1 level and the severity of coronary artery disease in patients with non-ST segment-elevated myocardial infarction

Abstract Background This study aimed to evaluate the association between plasma big endothelin-1 (ET-1) level and the severity of coronary artery disease assessed by the SYNTAX score (SS) in patient with non-ST segment-elevated myocardial infarction (NSTEMI). Methods A total of 766 patients with NSTEMI undergoing coronary angiography were recruited. Patients were divided into divided into three groups: low SS (SS ≤22), intermediate SS (23–32) and high SS group (SS &amp;gt;32). Spearman correlation, smooth curve fitting, logistic regression and Receiver operating characteristic (ROC) curve analysis were performed to evaluated the association between plasma big ET-1 level and the SS. Results There was a significant correlation between the big ET-1 and the SS (r=0.378, p&amp;lt;0.001). Smoothing curve indicated a positive correlation between plasma big ET-1 level and the SS, after adjustment for potential confounders. The ROC curve analysis showed that the area under the curve was 0.695 (0.661–0.727) and the optimal cutoff of plasma big ET-1 level were 0.35pmol/l, with a sensitivity of 68.9% and a specificity of 62.9%. Logistic regression showed that elevated big ET-1 was an independent predictor of intermediate-high SS in patients with NSTEMI, no matter entered as a continuous variable [OR (95% CI): 1.110 (1.053–1.170), p&amp;lt;0.001] or as a categorical variable [OR (95% CI): 2.873 (2.016–4.094), p&amp;lt;0.001]. The association between big ET-1 and intermediate-high SS was consistent across subgroups without significant interactions. Conclusion In patients presenting with NSTEMI, plasma big ET-1 level was significantly correlated with the SS. Elevated plasma big ET-1 level was an independent predictor for intermediate-high SS. Funding Acknowledgement Type of funding sources: None. ROC of big ET-1 for high SYNTAX score