Intermediate SYNTAX Score Research Articles

Outcomes of myocardial revascularization in patients with obesity and multivessel coronary artery disease

BackgroundThere is uncertainty regarding the best revascularization approach—whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)—for obese patients suffering from multi-vessel coronary artery disease.Results406 patients with low and intermediate SYNTAX scores (SS) underwent PCI with drug-eluting stents (n = 200, 100 with SS ≤ 22, and 100 with SS 23–32) and CABG (n = 206, 100 with SS ≤ 22, and 106 with SS 23–32). Patients were also categorized by body mass index (BMI): normal weight (12%, 48 patients), overweight (41.6%, 169 patients), and obese (46.6%, 189 patients). The follow-up period averaged 9 ± 1.9 years. The endpoints of the study were as follows: major adverse cardiac and cerebrovascular events, a repeat revascularization, diminished left ventricular ejection fraction (LVEF), and high SS (≥ 33) observed over time. When comparing PCI and CABG in overweight individuals, the risk of myocardial infarction (MI) following PCI was greater than after CABG (Hazard Ratio [HR] 2.7, 95% Confidence Interval [CI] 1.1–6.7, p = 0.03). In patients with overweight and Class I obesity, CABG was associated with the risk of coronary atherosclerosis progression (SS ≥ 33) (HR 4.4, 95% CI 1.5–13, p = 0.009 and HR 4.9, 95% CI 1.9–12, p = 0.001, respectively); whereas PCI was connected with the likelihood of repeat revascularization (HR 2.7, 95% CI 1.6–4.55, p < 0.0001 and HR 2, 95% CI 1.3–3.1, p = 0.002, respectively). At the same time, for stented patients, Class III obesity was associated with the risk of repeat revascularization (HR 2.5, 95% CI 1.02–6, p = 0.044).ConclusionThere were no significant weight-related impacts on long-term outcomes among patients who underwent surgery. Whereas in stented patients, Class III obesity was associated with the risk of repeat revascularization. When comparing PCI and CABG, for overweight and Class I obesity patients, CABG was associated with a likelihood of coronary atherosclerosis progression (SS ≥ 33), while PCI was linked to the risk of repeat revascularization. For overweight patients, CABG outperformed PCI in terms of the risk of MI. For other adverse events in patients of different weight categories, PCI and CABG did not reveal any significant benefits.

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With and Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials.

Diabetes may be associated with differential outcomes in patients undergoing left main coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The aim of this study was to investigate outcomes in patients with left main disease with and without diabetes randomized to PCI versus CABG. Individual patient data were pooled from 4 trials (SYNTAX [Synergy Between PCI With Taxus and Cardiac Surgery], PRECOMBAT [Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease], NOBLE [Nordic-Baltic-British Left Main Revascularisation Study], and EXCEL [Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization]) that randomized patients with left main disease to PCI or CABG. Patients were considered suitable for either approach. Patients were categorized by diabetes status. Kaplan-Meier event rates, Cox model hazard ratios, and interactions were assessed. Among 4393 patients, 1104 (25.1%) had diabetes. Patients with diabetes experienced higher rates of 5-year death (158/1104 [Kaplan-Meier rate, 14.7%] versus 297/3289 [9.3%]; P<0.001), spontaneous myocardial infarction (MI; 67/1104 [6.7%] versus 114/3289 [3.7%]; P<0.001), and repeat revascularization (189/1104 [18.5%] versus 410/3289 [13.2%]; P<0.001). Rates of all-cause mortality did not differ after PCI versus CABG in those with (84/563 [15.3%] versus 74/541 [14.1%]; hazard ratio, 1.11 [95% CI, 0.82-1.52]) or without (155/1634 [9.7%] versus 142/1655 [8.9%]; hazard ratio, 1.08 [95% CI, 0.86-1.36; PintHR=0.87) diabetes. Rates of stroke within 1 year were lower with PCI versus CABG in the entire population, with no heterogeneity based on diabetes status (PintHR=0.51). The 5-year rates of spontaneous MI and repeat coronary revascularization were higher after PCI regardless of diabetes status (spontaneous MI: 45/563 [8.9%] versus 22/541 [4.4%] in diabetes and 82/1634 [5.3%] versus 32/1655 [2.1%] in no diabetes, PintHR=0.47; repeat revascularization: 127/563 [24.5%] versus 62/541 [12.4%] in diabetes and 254/1634 [16.3%] versus 156/1655 [10.1%] in no diabetes, PintHR=0.18). For spontaneous MI and repeat revascularization, there were greater absolute risk differences beyond 1 year in patients with diabetes (4.9% and 9.9%) compared with those without (2.1% and 4.3%; PintARD=0.047 and 0.016). In patients with left main disease considered equally suitable for PCI or CABG and with largely low to intermediate SYNTAX scores, diabetes was associated with higher rates of death and cardiovascular events through 5 years. Compared with CABG, PCI resulted in no difference in the risk of death and a lower risk of early stroke regardless of diabetes status, and a higher risk of spontaneous MI and repeat coronary revascularization, with larger late absolute excess risks in patients with diabetes. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01205776, NCT0146651, NCT00422968, and NCT00114972.

The Role of N-Terminal-Pro-B-Type Natriuretic Peptide (NT-proBNP) and High-Sensitivity Troponin T (Hs-Troponin T) in the Evaluation of the Syntax Score in Patients With Acute Coronary Syndrome.

Background N-terminal-pro-B-type natriuretic peptide (NT-proBNP) is used to diagnose acute and chronic heart failure, but many studies show a strong and independent correlation between NT-proBNP serum levels and the severity and number of coronary artery damage. Meanwhile, the serum of high-sensitivity Troponin T (hs-Troponin T) has a very high prognostic value for the degree of coronary artery damage in patients with acute coronary syndrome. The SYNTAX score was developed to better predict the risks of percutaneous or surgical revascularization by considering the functional impact of the coronary circulation with all of its anatomic components, such as the presence of bifurcations, total occlusions, thrombus, calcification, and small vessels. Therefore, we conducted this study to understand the role of NT-proBNP and hs-troponin T in SYNTAX score evaluation in patients with acute coronary syndrome. Methodology A cross-sectional descriptive study of 86 patients diagnosed with acute coronary syndrome with indications for coronary angiography and intervention in the Department of Emergency and Interventional Cardiology, Cardiovascular Center, Hue Central Hospital, was conducted from June 2020 to May 2022. Results The mean age was 66.94 ± 10.61 years. The concentrations of NT-proBNP and hs-Troponin T in our study were 1115.9 ± 1623.3 pg/mL and 0.86 ± 1.55 ng/mL, respectively. The mean SYNTAX score in the study was 16.5 ± 7.5. There was a positive moderate correlation between the mean levels of NT-proBNP and the degree of coronary artery damage, as indicated by the SYNTAX score (P< 0.01, rho= +0.453). Conversely, there was a weak positive correlation between hs-Troponin T concentrations and the severity of coronary artery disease, based on the SYNTAX score (P < 0.01, rho = +0.387). The area under the curve (AUC) of the hs-Troponin T concentration value was 0.701, using a cutoff point of 0.109 ng/mL for hs-Troponin T concentration. This predicted the intermediate and high SYNTAX scores, with a sensitivity of 76% and a specificity of 59%. In comparison, the AUC of the NT-proBNP concentration value was 0.75, utilizing a cutoff point of 1120.5 pg/mL for NT-proBNP concentration. This predicted the intermediate and high SYNTAX scores, with a sensitivity of 60% and a specificity of 80.3%. Conclusions The levels of NT-proBNP had a positivemoderate correlation with the degree of coronary artery damage according to the SYNTAX score in patients with acute coronary syndrome. Hs-Troponin T levels of 0.109 ng/mL had higher sensitivity (76%) but lower specificity (59%) in predicting intermediate and high SYNTAX scores in patients with acute coronary syndromes than those of NT-proBNP levels of 1120.5 pg/mL, with a sensitivity of 60% and a specificity of 80.3%.

Distal left main stenting versus coronary artery bypass graft in intermediate syntax score

Distal left main stenting versus coronary artery bypass graft in intermediate syntax score

SYNTAX Score and 1-Year Outcomes in the OPTIVUS-Complex PCI Study Multivessel Cohort

The optimal revascularization strategy in patients with multivessel disease and intermediate SYNTAX score (SS) has not been fully elucidated. This study aimed to investigate the clinical outcomes of optimal intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) stratified by SS. This was a substudy of the OPTIVUS-Complex PCI study Multivessel Cohort, which aimed to meet the prespecified criteria for optimal stent expansion after IVUS-guided PCI. A total of 1,005 patients were divided into 3 groups according to SS: low, ≤22; intermediate, 23 to 32; and high, ≥33. The primary end points were major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of death, myocardial infarction, stroke, or coronary revascularization. The cumulative 1-year incidence of the primary end point was significantly higher in patients with high SS than in those with intermediate or low SS (25.0%, 10.9%, and 9.5%, respectively; p=0.003). This difference was mainly caused by the incidence of coronary revascularization. In the multivariable Cox proportional hazards models, the excess risk of patients with high versus low SS remained significant for the primary end point (hazard ratio 3.19, 95% confidence interval 1.65 to 6.16, p <0.001), whereas the excess risk of patients with intermediate versus low SS was no longer significant (hazard ratio 1.20, 95% confidence interval 0.72 to 2.01, p=0.46). After IVUS-guided multivessel PCI, patients with intermediate SS had a similar 1-year risk of MACCE to that of patients with low SS, whereas patients with high SS had a higher 1-year risk of MACCE than those with low SS.

Percutaneous coronary intervention vs. coronary artery bypass grafting in emergency and non-emergency unprotected left-main revascularization

BackgroundThe optimal revascularization strategy in patients with left main coronary artery (LMCA) disease in the emergency setting is still controversial. Thus, we aimed to compare the outcomes of percutaneous coronary interventions (PCI) vs. coronary artery bypass grafting (CABG) in patients with and without emergent LMCA disease.MethodsThis retrospective cohort study included 2138 patients recruited from 14 centers between 2015 and 2019. We compared patients with emergent LMCA revascularization who underwent PCI (n = 264) to patients who underwent CABG (n = 196) and patients with non-emergent LMCA revascularization with PCI (n = 958) to those who underwent CABG (n = 720). The study outcomes were in-hospital and follow-up all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE).ResultsEmergency PCI patients were older and had a significantly higher prevalence of chronic kidney disease, lower ejection fraction, and higher EuroSCORE than CABG patients. CABG patients had significantly higher SYNTAX scores, multivessel disease, and ostial lesions. In patients presenting with arrest, PCI had significantly lower MACCE (P = 0.017) and in-hospital mortality (P = 0.016) than CABG. In non-emergent revascularization, PCI was associated with lower MACCE in patients with low (P = 0.015) and intermediate (P < 0.001) EuroSCORE. PCI was associated with lower MACCE in patients with low (P = 0.002) and intermediate (P = 0.008) SYNTAX scores. In non-emergent revascularization, PCI was associated with reduced hospital mortality in patients with intermediate (P = 0.001) and high (P = 0.002) EuroSCORE compared to CABG. PCI was associated with lower hospital mortality in patients with low (P = 0.031) and intermediate (P = 0.001) SYNTAX scores. At a median follow-up time of 20 months (IQR: 10–37), emergency PCI had lower MACCE compared to CABG [HR: 0.30 (95% CI 0.14–0.66), P < 0.003], with no significant difference in all-cause mortality between emergency PCI and CABG [HR: 1.18 (95% CI 0.23–6.08), P = 0.845].ConclusionsPCI could be advantageous over CABG in revascularizing LMCA disease in emergencies. PCI could be preferred for revascularization of non-emergent LMCA in patients with intermediate EuroSCORE and low and intermediate SYNTAX scores.

CORRELATION BETWEEN LOW DIASTOLIC BLOOD PRESSURE AND SEVERITY OF CORONARY ARTERY DISEASE USING SYNTAX SCORE

Objective: Hypertension remains a leading cause of morbidity and mortality, and the optimum blood pressure target remains debated, especially in coronary artery disease, given concerns for reduced myocardial perfusion if diastolic blood pressure is too low. The aim of this work was to study the relationship between diastolic blood pressure (DBP) and severity, and burden of coronary artery disease (CAD) as quantified by SYNTAX Score. Design and method: Six hundred consecutive stable patients with signs or symptoms of CAD who underwent elective coronary angiography were included in the study. Patients were divided into three groups according to SYNTAX Score as low, intermediate, and high. Results: Patients were predominantly males (72%), their age ranged from 35 - 82 years, with mean age of 59.55 ± 9.44 years. 426 patients (71%) were hypertensive, 82.1%,69.4%,70% of high, intermediate, and low SYNTAX groups respectively had hypertension. SYNTAX score ranged from 2.0 – 53.0 with a mean of 17.32 ± 9.87. In DBP group &lt;60 mmHg, SYNTAX score ranged from 8.0 – 53.0 with a mean of 26.47 ± 10.59. In DBP group 60 – 69 mmHg, SYNTAX score ranged from 5.0 – 45.50 with a mean of 22.13 ± 7.77. In DBP group 70 – 79 mmHg, SYNTAX score ranged from 3.0 - 34.0 with a mean of 13.91 ± 7.09. In DBP group &gt; = 80 mmHg, SYNTAX score ranged from 2.0 – 46.50 with a mean of 12.90 ± 8.21, SYNTAX score was significant higher in DBP groups &lt;60 and 60 – 69 mmHg than other groups (p &lt; 0.001). High atherosclerotic burden was identified by the presence of intermediate or high SYNTAX score. The frequency of high atherosclerotic burden was significantly increased with decreasing DBP, for mean SYNTAX Scores of 41.1, 35.6, 10 and 13.3 in DBP &lt;60, 60 – 69, 70 – 79, and &gt; = 80 mmHg; p &lt; 0.0001 for all. There was negative significant correlation between diastolic blood pressure and SYNTAX score (rs = -0.471, p &lt; 0.001). Conclusions: A low DBP level had an independent association with high SYNTAX Score. Lower DBP, particularly &lt;60 mmHg, may be important to recognize a potential pathophysiological contribution of too low DBP in the development of complexity and increased atherosclerotic burden, which is identified by the presence of intermediate or high SYNTAX Score in stable patients with obstructive CAD.

Correlation of CRP level with intermediate and high Syntax Score in patients with acute coronary syndrome

In patients with acute coronary syndromes, inflammation has a major role in plaque rupture, which results in acute coronary artery obstruction. This vascular process is not limited only to the site of plaque destabilisation but also in the systemic level. So, it may be detected by determining plasma inflammatory markers. C-reactive protein (CRP) has been frequently studied in recent years and considered to be one of the most important markers. The SYNTAX score (SXscore) is a useful angiographic scoring system that has been developed to assess and quantify the extent, severity and complexity of coronary artery disease. In our study, we investigated whether baseline high-sensitivity CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 128 patients with ACS who underwent coronary angiography between January 2022 and November 2022. The patients were divided according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). A total of 128 patients met the inclusion criteria and was included in the study. Among those 128 patients, 98 (76%) were males and 30 (23%) were females. The mean age of patients in the intermediate-high SXScore (61 ± 12 years) group was significantly higher than the low SXScore group (57 ± 10 years) with a P-value: 0.003. Coronary risk factor frequencies such as hypertension were present in 45%, type 2 diabetes mellitus in 42% and dyslipidemia in 83% of patients with no significant difference between both groups except for diabetes with a significant P-value: 0.008. Subjects with an intermediate-high SXScore had higher values of serum glucose, creatinine, peak troponin, and uric acid levels compared to the low SXScore subjects. In addition, the intermediate-high SXScore group showed significantly higher values of high sensibility CRP than the lower SXScore (17.8 ± 6.4 mg/L versus 10.2 ± 5.3 mg/L, P < 0.001). One of the most important results in this study was that serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease.

Physiology-guided PCI versus CABG for left main coronary artery disease: insights from the DEFINE-LM registry

There have been no studies comparing clinical outcomes of physiology-guided revascularization in patients with unprotected left main coronary disease (ULMD) between percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG). The aim of this study was to assess the long-term clinical outcomes between PCI and CABG of patients with physiologically significant ULMD. From an international multicenter registry of ULMD patients interrogated with instantaneous wave-free ratio (iFR), we analyzed data from 151 patients (85 PCI vs. 66 CABG) who underwent revascularization according to the cutoff value of iFR ≤ 0.89. Propensity score matching was employed to adjust for baseline clinical characteristics. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, and ischemia-driven target lesion revascularization. The secondary endpoints were the individual components of the primary endpoint. Mean age was 66.6 (± 9.2) years, 79.2% male. Mean SYNTAX score was 22.6 (± 8.4) and median iFR was 0.83 (IQR 0.74–0.87). After performing propensity score matching analysis, 48 patients treated with CABG were matched to those who underwent PCI. At a median follow-up period of 2.8 years, the primary endpoint occurred in 8.3% in PCI group and 20.8% in CABG group, respectively (HR 3.80; 95% CI 1.04–13.9; p = 0.043). There was no difference in each component of the primary event (p > 0.05 for all). Within the present study, iFR-guided PCI was associated with lower cardiovascular events rate in patients with ULMD and intermediate SYNTAX score, as compared to CABG.Graphical abstractState-of-the-art PCI vs. CABG for ULMD. Study design and primary endpoint in patients with physiologically significant ULMD. MACE was defined as the composite of all-cause death, non-fatal myocardial infarction, and target lesion revascularization. The blue line denotes the PCI arm, and the red line denotes the CABG arm. PCI was associated with significantly lower risk of MACE than CABG. CABG: coronary artery bypass grafting; iFR: instantaneous wave-free ratio; MACE: major adverse cardiovascular events; PCI: percutaneous coronary intervention; ULMD: unprotected left main coronary artery disease.

STUDY OF RELATIONSHIP BETWEEN CAROTID INTIMA -MEDIA THICKNESS AND SYNTAX SCORE IN PATIENTS WITH ACUTE CORONARY WITH EMPHASIZING ON SHORT TREATMENT OUTCOMES

80 patients of age group 21 to 80 were studied for various traditional risk factors such as Hypertension, Diabetes, Dyslipidaemia, Post –Menopausal, Family History of CAD, Smoking and Alcoholism were noted. Majority patients have systemic hypertension followed smoking and alcoholism. According to classication of ACS based on ECG and Troponin, STEMI was present in 55 patients, NSTEMI in 15 patients and 10 patients reported unstable angina .Based on the coronary angiogram right dominant circulation was more. Majority of patients had 1 or more coronary arteries followed by Thrombus containing lesion, Long lesion Based on the syntax score majority reported &lt;23. There is a positive correlation between syntax score and carotid intima-media thickness which is statistically signicantly. Mortality was seen in intermediate and high syntax score group.

Association between Plasma Big Endothelin-1 Level and The Severity of Coronary Artery Disease in Patients with Non-ST Segment-Elevated Myocardial Infarction.

Early risk stratification with simple biomarkers is essential in patients with non-ST segment-elevation myocardial infarction (NSTEMI). This study aimed to evaluate the association between plasma big endothelin-1 (ET-1) level and the SYNTAX score (SS) in patients with NSTEMI. A total of 766 patients with NSTEMI undergoing coronary angiography were recruited. Patients were divided into three groups: low SS (≤22), intermediate SS (23-32), and high SS (>32). Spearman correlation, smooth curve fitting, logistic regression, and receiver operating characteristic (ROC) curve analysis were performed to evaluate the association between plasma big ET-1 level and the SS. A p-value <0.05 was considered statistically significant. There was a significant correlation between the big ET-1 and the SS (r=0.378, p<0.001). The smoothing curve indicated a positive correlation between the plasma big ET-1 level and the SS. 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 was 0.35pmol/l. Logistic regression showed that elevated big ET-1 was an independent predictor of intermediate-high SS in patients with NSTEMI, whether entered as a continuous variable [OR (95% CI): 1.110 (1.053-1.170), p<0.001] or as a categorical variable [OR (95% CI): 2.962 (2.073-4.233), p<0.001]. In patients with NSTEMI, the 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.

Long-term results of myocardial revascularization in patients with multivessel disease

Choosing the method of revascularization - coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) - remains debatable. We selected 406 patients with multivessel disease who underwent PCI with a drug-eluting stent (DES) (n = 200, 100 with a SYNTAX score (SS) ≤ 22 and 100 with a SS 23-32); and CABG (n = 206, 100 with a SS ≤ 22 and 106 with a SS 23-32). The mean follow-up period was 9±1.9 years. The endpoints of the study were as follows: major adverse cardiac and cerebrovascular events (МАССЕ), a repeat revascularization (RR), diminished left ventricular ejection fraction (LVEF), and high SS in dynamics. Patients with an intermediate SS needed RR more often with PCI than after CABG (64 % vs 22.6 %; HR: 3.52; CI: 2.19-5.66; р < 0.001). We found no significant differences for other MACCE between the groups. The decrease in LVEF was greater in the low SS subgroup in operated patients than after PCI (39.5 % vs 27.7 %; HR: 0.57; CI: 0.34-0.98; p = 0.04). The difference between the initial and final SS, was greater after the CABG than after PCI (43.5 % vs 10.9 %; HR: 0.26; CI: 0.14-0.47; р < 0.001). After 9 ± 1.9 years in intermediate SS group CABG exhibited an advantage over PCI with DES in terms of the MACCE indicators due to a smaller number of RR in the CABG group. The CABG group showed a more significant progression of atherosclerosis, and more heart failure cases (Tab. 2, Fig. 4, Ref. 29). Text in PDF www.elis.sk Keywords: coronary artery disease, coronary artery bypass grafting, percutaneous coronary intervention, SYNTAX score.

CHA2DS2-VASc-HSF Score as a Predictor of Severity of Coronary Artery Disease in Patients Undergoing Coronary Angiography

Background: Cardiovascular atherosclerosis, particularly coronary artery disease (CAD), represents the main reason for death prematurely over the world. Risk stratification and prevention by risk factor modification are crucial aspects of CAD therapy. The CHADS2 and CHA2DS2-VASc scores are effective in determining the risk of thrombosis in non-valvular atrial fibrillation (AF). The current research aimed to determine the CHA2 DS2-VASc-HSF score as a predictor for CAD severity in CAD patients after coronary angiography.&#x0D; Methods: This cross-sectional study was assessed on 100 patients who attended the coronary care unit and underwent coronary angiography. They were categorised into three groups: Group I: Low syntax scores (2-13), Group II: Intermediate syntax score (14-20), and Group III: High syntax score (21-40).&#x0D; Results: Our study showed that the SYNTAX score revealed a statistically significant relation with patient's age, gender, and presentation. Regarding the medical history of the studied participant in relation to SYNTAX score, most patients reported a history of HTN, DM, Dyslipidemia, CHF, and previous history of vascular disease showed intermediate and high SYNTAX score in comparison to those with normal blood pressure, glucose level, lipid profile, no CHF history and those no previous history. SYNTAX score showed significant relation with ejection fraction and CHA2 DS2-VASc-HSF score of the patient. Significant low ejection fraction in high SYNTAX score patients compared to low SYNTAX score patients. Significant high average of CHA2 DS2-VASc-HSF score among those with high and intermediate SYNTAX score compared to those with low SYNTAX score.&#x0D; Conclusions: CHA2DS2-VASc-HSF should be constituted as the ideal scoring scheme for predicting the severity of CAD. Risk scoring systems may be effective as predictors due to their simplicity and easy employment by physicians in ordinary practice without incurring additional costs.

A Novel Electrocardiographic Score Predicts the Severity of Coronary Artery Disease and Clinical Outcomes in Patients with Non-ST Segment Elevation Myocardial Infarction.

There are many electrocardiographic (ECG) changes in non-ST segment elevation myocardial infarction (NSTEMI). However, the diagnostic power is limited in determining the severity of coronary artery disease (CAD) and clinical outcomes. This study investigated the role of a risk-based ECG score in predicting the severity of CAD and clinical outcomes in NSTEMI patients. One hundred and fifty-two patients were enrolled in the study. Severe CAD was defined as; intermediate (> 22) or high SYNTAX score (> 32), three-vessel disease, and left main coronary artery lesions. A risk-based ECG score was calculated, and the patients were categorized. All patients were followed up, and mortality and repeat revascularizations were evaluated. The severe CAD group had a significantly higher risk-based ECG score than the non-severe CAD group (p = 0.013). The patients with a high risk-based ECG score had more severe CAD (p = 0.013), higher SYNTAX score (p < 0.001), more three-vessel disease (p = 0.003), coronary artery calcification (p = 0.02), and one-year mortality (p = 0.006) than those with medium or low ECG scores. Multivariate logistic regression analysis showed that a 1-point increase in the risk-based ECG score was associated with a 1.573-fold [95% confidence interval (CI): 1.111-2.227, p = 0.011] increase probability of severe CAD. Kaplan-Meier analysis demonstrated that the high-risk group had a significantly higher one-year mortality rate than the low-risk and moderate-risk groups (hazard ratio: 2.383, 95% CI: 1.395-4.072, p = 0.001). This study demonstrated that higher ECG scores were associated with a higher risk of severe CAD and worse clinical outcomes in NSTEMI patients.

Análise dos desfechos em intervenção coronária percutânea de tronco de coronária esquerda não protegido

Background: Significant lesions in the left main coronary artery are found in approximately 5% of patients undergoing coronary angiography, with most cases involving multiple vessels and affecting the distal bifurcation. A coronary artery bypass graft surgery is considered the preferred treatment for unprotected left main coronary artery lesions. However, with the advancement of techniques and the introduction of new drug-eluting stents, percutaneous coronary intervention has been considered a viable strategy, with favorable results. The objective of this study was to analyze the outcomes in patients with unprotected left main coronary artery lesions undergoing percutaneous coronary intervention. Methods: Electronic data from patients undergoing percutaneous coronary intervention between December 2017 and January 2020 at a single center were analyzed to assess clinical and angiographic characteristics and clinical outcomes. Results: A total of 103 patients with significant unprotected left main coronary artery lesions were included; in that, 66% were male, 88.3% were hypertensive, and 87.4% had normal ventricular function. Lesions involving the bifurcation were identified in 73.8% of patients, 36.9% had concomitant lesions in the three major epicardial vessels, and 42.7% had an intermediate SYNTAX score (23 to 32 points). Angiographic success was achieved in 100% of cases, with four (3.9%) adverse cardiac and cerebrovascular events, with 2.9% mortality. Conclusion: Hospital results support percutaneous coronary intervention as a safe procedure, with excellent angiographic results and low rates of adverse cardiac and cerebrovascular events. We concluded that PCI is an option to coronary artery bypass graft surgery and is a very viable option for surgical treatment of unprotected left main coronary artery lesions.

Correlation between the left ventricular strain and the severity of coronary atherosclerosis in patients with coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. The purpose of this study was to assess the properties of left ventricular myocardial deformation in patients with coronary artery disease (CAD) with various degrees of coronary lesions. Methods and Results: The study included 74 patients with stable angina pectoris Class II-IV aged between 40 and 70 years. All patients underwent the following examinations: assessment of traditional risk factors, physical examination, general clinical and laboratory blood tests, 12-lead ECG, 24-hour ABPM, transthoracic echocardiography, two-dimensional speckle tracking echocardiography (STE), and coronary angiography (CAG). The SYNTAX score was calculated retrospectively according to the SYNTAX score algorithm. All patients were divided into 3 groups: Group 1 included 21 patients with a low SYNTAX score (0–22), for whom standard drug therapy was recommended; Group 2 included 28 patients with an intermediate SYNTAX score (23–32), to whom PCI was recommended; Group 3 included 25 patients with a high SYNTAX score (≥33), to whom CABG was recommended. Left ventricular ejection fraction (LVEF) obtained using the modified biplane Simpson’s method was significantly lower in Group 3 than in Groups 1 and 2 (P = 0.001); it should be noted that this indicator was within the normative values in Groups 1 and 2, and belonged to the gradation "mild dysfunction." A more objective quantitative assessment of the contractile function of the LV myocardium was obtained by assessing the GLS and SR. The comparative analysis of the LV myocardial deformation properties in the three studied groups showed that in Group 3 the GLS and SR indicators were significantly lower than in Group 1 (P = 0.000 and P = 0.0020). Moreover, GLS (global longitudinal strain) and SR (strain rate) were significantly higher in Group 1 than in Group 2 (P = 0.0001 and P = 0.0133, respectively). GLS significantly correlated with LVEF (r = 0.57; P &amp;lt; 0.05), E/A (r = 0.22; P &amp;lt; 0.05), and SYNTAX score (r=-0.63; P &amp;lt; 0.05). SR significantly correlated with LVEF (r = 0.49; P &amp;lt; 0.05) and SYNTAX score (r=-0.37; P &amp;lt; 0.05) Conclusion The results obtained indicate the diagnostic value of STE with the determination of GLS and SR in a comprehensive assessment of the severity of CAD. GLS and SR significantly correlate with the clinical course of the disease, as well as indicators of LV remodeling and LV diastolic dysfunction. STE analysis of GLS and SR has incremental diagnostic value over transthoracic echocardiography in predicting significant CAD

The utility of SYNTAX score predictability by electrocardiogram parameters in patients with unstable angina

BackgroundSYNTAX score is one of the risk assessment systems to predict cardiac events in acute coronary syndrome patients. Despite the large number of SYNTAX score benefits, invasive methods such as coronary angiography are necessary to perform the scoring. We hypothesized that ECG parameters could predict the SYNTAX score in unstable angina patients.MethodsDuring the retrospective cohort study, a total number of 876 patients were diagnosed with unstable angina. After applying the exclusion criteria, 600 patients were divided into tertiles based on the SYNTAX scores as low (0–22), intermediate (23–32), and high (≥ 33). The association between ECG parameters and SYNTAX score was investigated.ResultsThe study included 65% men and 35% women with a mean age of 62.4 ± 9.97 years. The delayed transition zone of QRS complex, ST-depression in inferior-lateral territories or/and in all three territories, and T-wave inversion in lateral territory were significant (p < 0.05) independent predictors of intermediate SYNTAX score. High SYNTAX score was predicted by the presence of prolonged P wave duration, ST-depression in lateral territory or/and anterior-lateral territories, ST-elevation in aVR–III leads or/and aVR–III–V1 leads. Among those, all three territories ST-depression (AUC: 0.611, sensitivity: 75%, specificity: 51%) and aVR + III ST-elevation (AUC: 0.672, sensitivity: 50.12%, specificity: 80.50%) were the most accurate parameters to predict intermediate and high SYNTAX scores, respectively.ConclusionThe present study demonstrates that accompanying the STE in the right side leads (aVR, III, V1) with ST-depression in other leads indicates the patients with high SYNTAX score; meanwhile, diffuse ST-depression without ST-elevation is a marker for intermediate SYNTAX score in unstable angina patients and can be applied for early risk stratification and intervention.

Percutaneous coronary intervention in unprotected left main coronary artery stenosis: Mid-term outcomes of a single-center observational study

BackgroundPercutaneous coronary intervention (PCI) is an appropriate alternative to coronary artery bypass grafting (CABG) for revascularization of unprotected left main coronary artery (ULMCA) disease in patients with low-to–intermediate anatomic complexity or when the patient refuses CABG even after adequate counselling by heart team. We assessed the safety, in-hospital and mid-term outcomes of ULMCA stenting with drug-eluting stents (DES) in Indian patients. MethodsOur study was a retrospective analysis of patients who had undergone ULMCA PCI at a tertiary center, between March 2011 and February 2020. Clinical characteristics, procedural data, and follow-up data were analyzed. The primary outcome was a composite of major adverse cardiovascular and cerebrovascular events (MACCE) during the hospital stay and at follow-up. The median follow-up was 2.8 years (interquartile range: 1.5–4.1 years). Results661 patients (mean age, 63.5 ± 10.9 years) had undergone ULMCA PCI. The mean SYNTAX score was 27.9 ± 10.4 and the mean LVEF was 58.0 ± 11.1%. 3-vessel disease and distal lesions were noted in 54% and 70.6% patients, respectively. The incidence of in-hospital MACCE was 1.8% and the MACCE during follow-up was 11.5% (including 48 [8.4%] cardiac deaths). The overall survival rates after one, three, five, and nine years were 94%, 88%, 84%, and 82%, respectively. The multivariate analysis revealed that age >65 years and high SYNTAX scores were independent predictors of mid to long-term mortality. ConclusionULMCA PCI with DES is safe and has acceptable in-hospital and mid-term outcomes among patients with low-to–intermediate SYNTAX score.

Systemic Immune-Inflammation Index Predicted Presence and Severity of Coronary Artery Disease

Objective: We aimed to investigate whether systemic immune-inflammation index, an easily available inflammatory and immune response marker, is associated with SYNTAX score (SS) in patients admitted with suspected CAD who underwent coronary angiography (CAG). Materials and Methods: Evaluated retrospectively were 456 patients who CAG from the cardiology outpatient clinic between January 2020 and January 2022. The SII was calculated by the formula neutrophil × platelet / lymphocyte. SS scores were divided into 3 groups as &lt;22 (lowest), 22-32 (intermediate), and ≥32 (highest). Those with an SS of 0 were taken as the control group. Results: Median were higher in CAD group compared to control group SII (631.0 vs 381.5, p&lt; 0.001), and a positive correlation was found between SS and SII (r= 0.578, p&lt;0.001) levels. Median SII levels were found to be higher as SS severity increased (p&lt; 0.05 for each SS group). The cut-off value of SII in predicting the presence of CAD was &gt;594.2, with 56.7% sensitivity and 91.1% specificity (AUC ± SE = 0.807 ± 0.020, p &lt; 0.001). In addition, it was found that SII predicted lowest SS group compared to the control group (OR = 1.06; p &lt; 0.001), intermediate SS compared to lowest SS (OR = 1.03; p &lt; 0.001), and highest SS compared to intermediate SS (OR = 1.04; p &lt; 0.001). Conclusion: SII has the potential to be a screening marker for presence and severity of CAD before CAG. This study demonstrates that SII is independently associated with coronary atherosclerosis burden.

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.