SXscore In Patients Research Articles

The relationship between advanced lung cancer inflammation index and high SYNTAX score in patients with non-ST-elevation myocardial infarction.

The advanced lung cancer inflammation index (ALI) is an independent prognostic biomarker of inflammation and nutrition in various types of cancer, acute heart failure and acute coronary syndrome. The SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score (SXscore) is an angiographic scoring tool used to determine the extent and severity of coronary artery disease. To investigate the relationship between ALI and coronary artery lesion complexity assessed using the SXscore in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Between February and November 2020, a total of 284 patients with NSTEMI were included consecutively. ALI was calculated with the formula body mass index (BMI) × serum albumin concentration/neutrophil-to-lymphocyte ratio (NLR). SXscore was calculated using the online calculator and divided into two groups - low (< 32) and high (≥ 33) - and then analyzed. Patients with a high SXscore had lower ALI (22.4 ±7.3 vs. 58.5 ±44.3, p = 0.016). In the univariable analysis, age (p = 0.046), BMI (p = 0.021), C-reactive protein (p = 0.002), peak troponin I (p = 0.009), NLR (p = 0.025), serum albumin (p = 0.003) and ALI (p < 0.001) were significantly associated with a high SXscore. ALI emerged as an independent predictor of a high SXscore in multivariable analysis (95% CI: 0.931-0.984, p = 0.002). The ALI may be useful as a simple tool for predicting high SXscore in patients with NSTEMI. To our knowledge, this is the first study to examine the relationship between ALI and severity of CAD.

Highly-Sensitive C-reactive Protein Level and its Association with Intermediate and High Syntax Score in cases of Acute Coronary Syndrome

Background: Highly-Sensitive C-reactive Protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). Aim: We investigated if baseline hs-CRP levels are correlated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). Subjects and methods: We investigated 200 patients with ACS who underwent coronary angiography. The patients were divided into groups based on their SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). Results: Patients in the intermediate-high SXScore group had higher serum hs-CRP levels in comparison to low SXScore group (4.61 ±1.54 mg/dL versus 2.37 ± 0.66 mg/dL, P < 0.001). The mean age of patients and prevalence of diabetes in the intermediate-high SXScore group were statistically insignificantly than in the low SXScore group. Left ventricular ejection fraction (LVEF) was significantly lower in the patients with an intermediate-high SXScore (41±9 %) compared to low SXScore tertiles (50±8 %) (P< 0.001). There was significant correlation between the hs-crp levels and the syntax score. The correlation coefficient (r) = 0.567, also p value was significant p=0.0001. Consecutively hs-CRP at a cut-off point of ≥ 2.5mg/L was highly sensitive (97%) and specific (41%) and was a strongly independent predictor of a high SXScore in patients with ACS. Where accuracy of test was (acc= 0.94). Conclusion: It is believed that serum levels of hs-CRP on admission in patients with ACS thought to be a strong predictor of the severity and complexity of coronary atherosclerosis together with multivessel disease, and LVEF.

Highly-Sensitive C-reactive Protein Level and its Association with Intermediate and High Syntax Score in cases of Acute Coronary Syndrome

Background: Highly-Sensitive C-reactive Protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). Aim: We investigated if baseline hs-CRP levels are correlated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). Subjects and methods: We investigated 200 patients with ACS who underwent coronary angiography. The patients were divided into groups based on their SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). Results: Patients in the intermediate-high SXScore group had higher serum hs-CRP levels in comparison to low SXScore group (4.61 ±1.54 mg/dL versus 2.37 ± 0.66 mg/dL, P < 0.001). The mean age of patients and prevalence of diabetes in the intermediate-high SXScore group were statistically insignificantly than in the low SXScore group. Left ventricular ejection fraction (LVEF) was significantly lower in the patients with an intermediate-high SXScore (41±9 %) compared to low SXScore tertiles (50±8 %) (P< 0.001). There was significant correlation between the hs-crp levels and the syntax score. The correlation coefficient (r) = 0.567, also p value was significant p=0.0001. Consecutively hs-CRP at a cut-off point of ≥ 2.5mg/L was highly sensitive (97%) and specific (41%) and was a strongly independent predictor of a high SXScore in patients with ACS. Where accuracy of test was (acc= 0.94). Conclusion: It is believed that serum levels of hs-CRP on admission in patients with ACS thought to be a strong predictor of the severity and complexity of coronary atherosclerosis together with multivessel disease, and LVEF.

Correlation between coronary artery lesion quantitative score and OSAHS and relative risk factors.

The purpose of this study was to investigate the relationship of obstructive sleep apnea hypopnea syndrome (OSAHS) with coronary artery lesion quantitative score Syntax Score (SX score) and risk factors for coronary heart disease (CHD). A total of 115 patients with OSAHS admitted to the Department of Cardiology in our hospital from January 2011 to June 2015 were selected. Philips Respironics Alice 5 Polysomnography was used for sleep monitoring. The patients were divided into mild group (n=32), moderate group (n=36) and severe group (n=47) according to apnea hypopnea index (AHI). Coronary angiography was performed for the patients, and SX score was calculated. Fasting venous blood was extracted from all patients with OSAHS and sent for detection of blood routine, coagulation, liver and kidney function, blood lipid and other indexes, and all patients received color Doppler echocardiography. The body weight and body mass index (BMI) of patients with OSAHS in severe group were higher than those in the mild group and moderate group (p<0.05). The content of fibrinogen (FIB) of patients in severe group was higher than that in mild group (p<0.01). The levels of total cholesterol (TC) (p<0.05), blood uric acid (p<0.05), and serum creatinine (p<0.01) of patients in the severe group were significantly higher than those in mild group and moderate group, but there were no differences between mild group and moderate group (p>0.05). Echocardiography suggested that the left atrium diameter 1 (LAD) and pulmonary artery pressure (PAP) of patients in severe group were larger than those in the mild group and moderate group (p<0.01), and the right ventricle anteroposterior diameter (RVD) in the mild group was smaller than those in the moderate group (p<0.05) and severe group (p<0.01). The score of patients with OSAHS in the severe group was higher than those in the mild group and moderate group (p<0.01), and SX score was increased with AHI (r=0.416, p<0.01). Logistic regression analysis showed that AHI and SX score could not be used as indicators to judge the prognosis of patients. There is a positive correlation between AHI and SX score in patients with OSAHS, indicating that with the aggravation of respiratory sleep disorder, SX score is increased significantly and the severity of coronary artery lesion is increased accordingly.

Neutrophil to lymphocyte ratio correlate with syntax score in patients with non st elevation acute coronary syndrome

Introduction: In this study we aimed to investigate the correlation between the neutrophil to lymphocyte ratio (NLR) and severity of coronary artery disease (CAD) in patients with Non ST elevation acute Coronary Syndrome (NSTE-ACS) using the SYNTAX score (SXscore). Method: A total of 150 patients with NSTE-ACS who underwent coronary angiography were enrolled in the study. NLR was measured for all patients at presentation. The study population was then divided into 3 tertiles based on the SYNTAX trial results (1). The low syntax group (n = 25) was defined as those with an SXscore ≤ 22, the intermediate syntax group (n = 78) was defined as an SXscore ≥ 23 and < 33, and the high syntax group (n = 47) as those with an SXscore ≥ 33. Result: NLR was significantly lower in patients with a low SXscore compared to patients with an intermediate SXscore or high SXscore (2.4 ± 2 to 4.8 ± 2 and 6.9 ± 3, P < 0.001). Linear regression analysis revealed that NLR (coefficient β = 0.470, 95%CI: 1.273-1.935, P < 0.001) was significantly associated with the SXscore in patients with NSTE-ACS. Conclusion: Our results indicate that NLR is independently associated with the severity of CAD in patients with NSTE-ACS.

The Association Between Serum Procalcitonin Levels and Severity of Coronary Artery Disease Assessed by SYNTAX Score in Patients With Acute Coronary Syndrome.

The SYNTAX score (SX score) is a useful score for assessing the severity of coronary artery disease (CAD). Previous studies have demonstrated a close relationship between SX score and inflammation. Procalcitonin (PCT) is an early inflammatory marker, especially during sepsis. Thus, in this study, we aimed to investigate the relationship between SX score and serum PCT levels. A total of 545 patients were enrolled in this prospective cross-sectional study and were divided into 2 subgroups, according to their SX score. Serum PCT and high-sensitivity C-reactive protein levels were measured. Serum PCT levels were higher in the high SX score group compared to the low-intermediate SX score group (P < .001). Serum PCT levels were an independent predictor of a high SX score in patients with acute coronary syndrome (P = .001). As patients with a higher SX score had increased serum PCT levels on admission, serum PCT may be useful for identifying patients with severe CAD.

The association of plasma fibrinogen with the extent and complexity of coronary lesions in patients with acute coronary syndrome.

High Syntax score (SXscore) is associated with more serious disease and worse prognosis in patients with acute coronary syndrome (ACS). Plasma fibrinogen levels are associated with poor cardiovascular outcomes. To investigate the relation of admission fibrinogen levels with intermediate-high SXscore in patients with ACS. A total of 752 patients (61.6 ± 12.8 years, 67.3% men) with ACS, who underwent urgent coronary angiography (CAG) were enrolled. Laboratory data including fibrinogen and high sensitivity C-reactive protein were obtained before CAG. Syntax scores of all patients were calculated from baseline CAG. The patients were divided into two groups: low SXscore (≤ 22) and intermediate-high SXscore (≥ 23). Admission fibrinogen levels were significantly higher in the SXscore ≥ 23 group when compared with the SXscore ≤ 22 group (median 492 mg/dL, interquartile range 428-581 mg/dL vs. median 370 mg/dL, interquartile range 309-428 mg/dL, respectively; p < 0.001). In multivariate analysis, the independent predictors of intermediate-high SXscore were fibrinogen (OR 1.008, 95% CI 1.005-1.010, p < 0.001), left ventricular ejection fraction (OR 0.935, p < 0.001), and age (OR 1.029, p = 0.041). A level of fibrinogen > 417 mg/dL had an 80.0% sensitivity and 71.3% specificity in predicting intermediate-high SXscore. Increased fibrinogen levels are independently associated with intermediate-high SXscore in patients with ACS.

The role of GRACE score in the prediction of high-risk coronary anatomy in patients with non-ST elevation acute coronary syndrome.

In patients with non-ST elevation acute coronary syndrome (NSTE-ACS), identification of the patients with high-risk coronary anatomy (HRCA) who are most likely to require coronary artery bypass grafting (CABG) is crucial. The SYNTAX score (SXscore) is an angiographic grading tool designed to determine the complexity of coronary artery disease. It appears that CABG offers significantly better outcomes in patients with SXscore ≥ 33, which shows severe HRCA. We sought to assess the accuracy of the GRACE score in predicting HRCA in terms of SXscore in patients with NSTE-ACS. Patients admitted to our coronary unit with a diagnosis of NSTE-ACS and undergoing coronary angiography during hospitalisation were recruited to this study. Patients were categorised into two groups based on SXscore: HRCA (SXscore ≥ 33) and low-risk coronary anatomy (LRCA, SXscore < 33). The cut-off level of GRACE score for HRCA was established by receiver operator characteristic (ROC) analysis. We studied 207 consecutive patients (mean age: 59 ± 11 years, 27.5% female). The GRACE score was 139 ± 34 in the HRCA group and 114 ± 33 in the LRCA group (p = 0.001). There was a significant positive correlation between SXscore and GRACE score (r = 0.338, p < 0.001). The area under ROC curve for GRACE score was 0.71 (95% CI 0.60-0.81, p = 0.001). A GRACE score of 123 was identified as the optimal cut-off to predict HRCA with a sensitivity of 71% and a specificity of 60%. In multivariate regression analysis, GRACE score ≥ 123 was the only variable that identified HRCA (OR 2.8, 95% CI 1.18-6.6, p = 0.019).Conclusions: Our study demonstrates that, in the setting of NSTE-ACS, patients with HRCA, who are most likely to require CABG, have higher GRACE scores at presentation. However, the ability of GRACE score to predict HRCA was modest.

Association of thiol/disulfide ratio with syntax score in patients with NSTEMI

Objective. The aim of this study was to investigate the relation between native thiol/disulfide ratio (TDR) and severity of coronary atherosclerosis as assessed by the Syntax score (SXscore) in patients with non-ST elevation myocardial infarction (NSTEMI) who underwent coronary angiography. Material and Methods. A total of 290 patients with NSTEMI who underwent coronary angiography, were included in the study between January and August 2014. Baseline coronary angiography determined the SXscore. The patients were divided into two groups: one with low SXscores (< 23) and the other with high SXscores (≥ 23). Results. TDR was significantly lower in patients with high SXscores (p < 0.001). In-hospital mortality was higher in the group with low TDR and high SXscores. The cut-off value of TDR on admission that predicted a high SXscore in the groups combined was 14, with a sensitivity of 73% and a specificity of 68%. Conclusion. TDR can be determined by an easy, inexpensive, automated, or optionally manual spectrophotometric assay, and correlates inversely with SXscore in patients with NSTEMI.

OP-079 The Role of GRACE Score in Prediction of High Risk Coronary Anatomy in Patients with Non-ST Elevation Acute Coronary Syndrome

Background: In patients with non-ST elevation acute coronary syndrome (NSTE-ACS), identification of the patients with high-risk coronary anatomy (HRCA) who are most likely to require coronary artery bypass grafting (CABG) is crucial. The SYNTAX score (SXscore) is an angiographic grading tool designed to determine the complexity of coronary artery disease. It appears that CABG offers significantly better outcomes in patients with SXscore ≥ 33, which shows severe HRCA. Aim: We sought to assess the accuracy of the GRACE score in predicting HRCA in terms of SXscore in patients with NSTE-ACS. Methods: Patients admitted to our coronary unit with a diagnosis of NSTE-ACS and undergoing coronary angiography during hospitalisation were recruited to this study. Patients were categorised into two groups based on SXscore: HRCA (SXscore ≥ 33) and low-risk coronary anatomy (LRCA, SXscore < 33). The cut-off level of GRACE score for HRCA was established by receiver operator characteristic (ROC) analysis. Results: We studied 207 consecutive patients (mean age: 59 ± 11 years, 27.5% female). The GRACE score was 139 ± 34 in the HRCA group and 114 ± 33 in the LRCA group (p = 0.001). There was a significant positive correlation between SXscore and GRACE score (r = 0.338, p < 0.001). The area under ROC curve for GRACE score was 0.71 (95% CI 0.60–0.81, p = 0.001). A GRACE score of 123 was identified as the optimal cut-off to predict HRCA with a sensitivity of 71% and a specificity of 60%. In multivariate regression analysis, GRACE score ≥ 123 was the only variable that identified HRCA (OR 2.8, 95% CI 1.18–6.6, p = 0.019). Conclusions: Our study demonstrates that, in the setting of NSTE-ACS, patients with HRCA, who are most likely to require CABG, have higher GRACE scores at presentation. However, the ability of GRACE score to predict HRCA was modest.

Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with non-ST segment elevation myocardial infarction.

In this study we aimed to investigate whether there is an association between the neutrophil to lymphocyte ratio (NLR) and severity of coronary artery disease (CAD) in patients with non-ST segment elevation myocardial infarction (NSTEMI) using the SYNTAX score (SXscore). A total of 414 patients with NSTEMI who underwent coronary angiography were enrolled in the study. NLR was measured for all patients at presentation. The study population was then divided into 3 tertiles based on the SYNTAX trial results.(1)) The low syntax group (n = 329) was defined as those with an SXscore ≤ 22, the intermediate syntax group (n = 58) was defined as an SXscore ≥ 23 and < 33, and the high syntax group (n = 27) as those with an SXscore ≥ 33. NLR was significantly lower in patients with a low SXscore compared to patients with an intermediate SXscore or high SXscore (3.7 ± 4 to 4.6 ± 2 and 7.9 ± 4, P < 0.001). Linear regression analysis revealed that NLR (coefficientβ = 0.380, 95%CI: 1.165-1.917, P < 0.001) was significantly associated with the SXscore in patients with NSTEMI. Our results indicate that NLR is independently associated with the severity of CAD in patients with NSTEMI.

Association of Platelet-to-Lymphocyte Ratio With Severity and Complexity of Coronary Artery Disease in Patients With Acute Coronary Syndromes

The SYNTAX score (SXscore) is an anatomic scoring system based on coronary angiography (CA) that not only quantifies lesion severity and complexity but also predicts poor cardiovascular outcomes, including mortality, in patients with acute coronary syndromes (ACS). Recent studies have shown that platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in many cardiovascular diseases. The aim of this study was to investigate the association of PLR with the severity and complexity of coronary atherosclerosis as assessed by the SXscore in patients with ACS who underwent urgent CA. A total of 1,016 patients with ACS who underwent urgent CA were included in the study from August 2012 to March 2014. Admission PLR values were calculated before CA was performed. The SXscore was determined from baseline CA. The patients were divided into 2 groups, those with low SXscores (≤22) and those with intermediate to high SXscores (≥23). PLRs were significantly higher in patients with intermediate to high SXscores compared with those with low SXscores (p<0.001). In-hospital mortality was significantly higher in the groups with high PLR and intermediate to high SXscores. In multivariate analysis, the independent predictors of intermediate to high SXscore were PLR (odds ratio 1.018, 95% confidence interval 1.013 to 1.023, p<0.001) together with the left ventricular ejection fraction (odds ratio 0.935, 95% confidence interval 0.910 to 0.960, p<0.001), and age (odds ratio 1.029, 95% confidence interval 1.029 to 1.054, p=0.02). A PLR≥116 had 71% sensitivity and 66% specificity in predicting intermediate to high SXscore. In conclusion, the PLR at admission is significantly associated with the severity and complexity of coronary atherosclerosis in patients with ACS. Increased PLR is an independent predictor of higher SXscore in patients with ACS who undergo urgent CA.

GW24-e1017 Association of cystatin C-based glomerular filtration rate with SYNTAX score in patients with diabetes

ObjectivesSerum cystatin C has been proposed as a better marker of glomerular filtration rate than serum creatinine. SYNTAX score (SXscore) can accurately reflect the severity of coronary artery disease (CAD)....

Association of Cystatin C-Based Glomerular Filtration Rate with SYNTAX Score in Patients with Diabetes

Serum cystatin C has been proposed as a better marker of glomerular filtration rate than serum creatinine. SYNTAX score (SXscore) can accurately reflect the severity of coronary artery disease (CAD). However, the association between Cystatin C-based glomerular filtration rate (eGFRcys) and SXscore in patients with diabetes has never been reported. We prospectively included 656 consecutive patients with diabetes who were angiographically diagnosed with CAD from January 2010 to December 2011. Renal function was assessed by eGFRcys. SXscore was calculated using SXscore algorithm. Ordinal logistic regression and Pearson correlation were used to analyze the association between eGFRcys and SXscore. Patients with renal dysfunction were older, more often female, more likely to have a history of hypertension and less tobacco use when compared with those patients with normal renal function. Age, sex, SBP, DBP, fasting glucose, HbA1c, TC, LDL, HDL, TG, BMI and CRP were not different among SXscore tertile groups. Incidence of hypertension, hyperlipidemia, family history and tobacco use were similar among these groups. Correlation analysis suggested that eGFRcys was negatively correlated with SXscore (R=-0.255, P<0.001). Ordinal logistic regression showed that eGFRcys was an independent predictor of SXscore (β=-0.027, P<0.001). eGFRcys was an independent predictor of SXscore in patients with diabetes. This might help explain the increased risk of CVD events and mortality in patients with renal dysfunction. Further prospectively multiple centre studies are required to better quantify this finding.

Bilirubin Levels and the Burden of Coronary Atherosclerosis in Patients With STEMI

We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of high levels of SYNTAX score (SXscore) in patients with acute myocardial infarction. Patients (n = 281; male 77%; mean age 60 ± 12) who were admitted with ST-elevation myocardial infarctions (STEMIs) were enrolled. Patients were divided into 2 groups. Group 1 was defined as SXscore <22 and group 2 was defined as SXscore ≥22. Total bilirubin levels were significantly higher in the high-SXscore group than in the low-SXscore group (0.86 ± 0.42 vs 1.02 ± 0.51, P = .005). A significant correlation was detected between total bilirubin and SXscore (r = .42; P = .001). At multivariate analysis, total bilirubin (odds ratio: 1.86, 95% confidence interval 1.04-3.35; P = .038) was an independent risk factor for high SXscore in patients with STEMI. In conclusion, serum bilirubin level is independently associated with SXscore in patients with STEMI.

The Relationship Between Kidney Function and Angiographically-Derived SYNTAX Score

Background Chronic kidney disease (CKD) is highly prevalent in patients with coronary artery disease (CAD) and is an independent risk factor for adverse cardiovascular disease (CVD) and all-cause mortality in patients with acute coronary syndromes. SYNTAX score (SXscore) can predict the outcomes of patients undergoing percutaneous coronary intervention. However, the association between kidney function and SXscore has not been previously reported. Methods The estimated glomerular filtration rate (eGFR) and SXscore were retrospectively collected in 2262 patients with established CAD undergoing coronary angiography at Peking University Third Hospital from March 2005 to September 2010. Ordinal logistic regression and Pearson and partial correlation were used to analyze the association between eGFR and SXscore. Results Patients with renal dysfunction were older, more likely to be female, and have a history of hypertension and diabetes. The unadjusted correlation coefficient of eGFR and SXscore was −0.125 ( P < 0.001).This remained significant after adjustment for age, sex, hypertension, diabetes, hyperlipidemia, or current smoking ( r = −0.075, P = 0.019). Ordinal logistic regression showed that age, gender, diabetes, and eGFR exerted independent influences on SXscore. Conclusions Kidney function was an independent predictor of SXscore in patients with established CAD. This helps explain the increased risk of cardiovascular disease events and mortality in patients with renal dysfunction. Further prospective multicentre studies are needed to confirm this finding.