Value Of SYNTAX Score Research Articles

Gender-Dependent Association Between Thyroid Hormones and Severity of Coronary Artery Disease by SYNTAX Score

Thyroid function has been shown to be associated with cardiovascular diseases. Moreover, sex can influence on the association between thyroid function and other diseases. We aimed to evaluate the relationship between thyroid hormones and the severity of coronary artery disease (CAD) and outcomes. In a prospective study, patients with chest pain undergoing diagnostic coronary angiography were evaluated. Patients were categorized based on the number of involved coronary arteries. Moreover, the severity of CAD was quantitatively calculated using the Syntax score (SS). All patients were also followed up for 3-month duration. The level of TSH in 150 patients was significantly higher in females than males (3.1 [1.7, 5] versus 1.8 [1, 3.3] mU/L; P=0.002). There was significant correlation between THS and the SS among females (ρ=0.477, P<0.001), but not males. Among both sexes, thyroid hormones were comparable between those with or without events during follow-up. The main predictors of high SS values included age (odds ratio [OR] 1.060, 95% confidence interval [CI] 1.018-1.104; P=0.005) and female (OR 2.941, 95% CI 1.198-7.218). The main predictors of multivessel disease were age (OR 1.077, 95% CI 1.026-1.132), female (OR 5.853, 95% CI 1.880-18.222), thyroxin (OR 0.733, 95% CI 0.547-0.981), and thyrotropin (OR 1.333, 95% CI 1.079-1.647). Thyroid hormones are associated with the presence and the severity of CAD, but it might be sex-related. However, thyroid hormone levels could not predict short-term outcomes of patients.

Outcomes According to Coronary Disease Complexity and Optimal Thresholds to Guide Revascularization Approach: FAME 3 Trial

BackgroundCoronary disease complexity is commonly used to guide revascularization strategy in patients with multivessel disease (MVD). ObjectivesThe aim of this study was to assess the interactive effects of coronary complexity on percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) outcomes and identify the optimal threshold at which PCI can be considered a reasonable option. MethodsA total of 1,444 of 1,500 patients with MVD from the FAME (Fractional Flow Reserve versus Angiography for Multi-vessel Evaluation) 3 randomized trial were included in the analysis (710 CABG vs 734 PCI). SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores were transformed into restricted cubic splines, and logistic regression models were fitted, with multiplicative interaction terms for revascularization strategy. Optimal thresholds at which PCI is a reasonable alternative to CABG were determined on the basis of Cox regression model performance. ResultsThe mean SYNTAX score (SS) was 25.9 ± 7.1. SS was associated with 1-year major adverse cardiac and cerebrovascular events among PCI patients and 3-year death, myocardial infarction, and stroke among CABG patients. Significant interactions were present between revascularization strategy and SS for 1- and 3-year composite endpoints (P for interaction <0.05 for all). In Cox regression models, outcomes were comparable between CABG and PCI for the 3-year primary endpoint for SS ≤24 (P = 0.332), with 44% of patients below this threshold and 32% below the conventional SS threshold of ≤22. ConclusionsIn patients with MVD without left main disease, PCI and CABG outcomes remain comparable up to SS values in the mid- rather than low 20s, which allows the identification of a greater proportion of patients in whom PCI may be a reasonable alternative to CABG.

The role of syntax score on survival in young acute coronary syndrome patients.

The study aimed to evaluate the effect of the SYNTAX score (SS) calculated before percutaneous intervention on survival in a group of young patients with acute coronary syndrome (ACS). Our study is a retrospective study. Patients between the ages of 18 and 45 who applied to Private Yalova Atakent Hospital Cardiology Clinic with ACS and underwent percutaneous coronary intervention between 01.01.2017 and 01.12.2023 were included in the study. Patients aged 45 and under who presented with acute syndrome and underwent coronary angiography were evaluated. Patients' history of major cardiac adverse events (MACE) was evaluated. Demographic characteristics, laboratory findings, echocardiographic parameters, and SS of the patients were recorded. SS was calculated from the coronary angiography images of the patients. 140 patients were included in the study. 70.0% (n=98) of the cases were diagnosed with ST-elevation myocardial infarction (STE-MI), 28.6% (n=40) with non-ST-elevation myocardial infarction (NSTE-MI)-unstable angina pectoris (USAP), and 1.4% with cardiac arrest (n=2). 28.6% (n=40) of the patients had MACE. There was a statistically significant correlation between SS and MACE (r=0.525 p=0.001). An SS value of 23.15 had 77.5% sensitivity and 60.8% specificity in predicting MACE. There was a statistically significant negative correlation between SS and ejection fraction (EF) (r=-0.584, p=0.001). EF<40.5 predicted mortality with 77.7% sensitivity and 69.4% specificity (AUC 0.710, p=0.01, 95% CI 0.615-0.825). SYNTAX Score and EF have predictive value in predicting MACE and mortality in young ACS patients. Different scoring systems are needed to predict MACE and mortality after ACS in young patients.

Very long-term prognostic value of clinical SYNTAX score in patients undergoing percutaneous coronary intervention for left main coronary artery disease

Abstract Background Recently, long-term prognostic value of SYNTAX score (SS) has been validated in patients with left main coronary artery disease (LMCA). However, the ability of clinical SYNTAX score (CSS) to predict very long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) for LMCA has not been fully investigated yet. Purpose We aimed to validate the impact of CSS on very long-term outcomes in patients undergoing PCI for LMCA. Methods Between June 2006 and December 2012, 279 patients underwent unprotected LMCA PCI were analyzed. The SS for each patient was calculated by scoring all coronary lesions using SS algorithm. CSS was calculated by multiplying the SS to an ACEF score (age/left ventricular ejection fraction + 1 if serum creatinine&amp;gt;2mg/dL). Major adverse cardiac events (MACEs) were defined as death, non-fatal myocardial infarction, and revascularizations. Mean follow-up duration was 2,529±1664 days. Results The CSS (26.8±11.9 versus 39.9±26.1, p&amp;lt;0.001) as well as SS (23.2±6.9 versus 25.8±7.9, p=0.003) was significantly higher in patients with MACEs. Area under the curve for MACEs (0.672 versus 0.599, p=0.0023) and mortality (0.744 versus 0.626, p&amp;lt;0.0001) of CSS was significantly higher compared with those of SS (Figure 1). The CSS significantly improved the reclassification and the integrated discrimination of patients compared to SS. Log CSS was an independent predictor for MACEs (hazard ratio [HR] 5.37, 95% confidence interval [CI] 1.98 – 14.61; p = 0.006) and mortality (HR 11.69, 95% CI 3.30 – 41.31; p &amp;lt; 0.001). When patients were categorized into 3 groups according to tertiles of CSS (Low CSS ≤ 22, 22 &amp;lt; Mid CSS ≤ 34, High CSS &amp;gt; 34), patients in the highest CSS tertile had significantly higher rates of MACEs (log-rank p&amp;lt;0.001) and mortality (log-rank p&amp;lt;0.001) compared with those in the lower 2 tertiles (Figure 2). The highest CSS tertile was an independent predictor for MACEs (HR 2.33, 95% CI 1.42 – 3.82; p = 0.001) and mortality (HR 5.66, 95% CI 2.20 – 14.57; p &amp;lt; 0.001). Conclusions The CSS is useful to predict very long-term clinical outcome in patients underwent unprotected LMCA PCI.

The relationship between lymphocyte DNA damage, coronary artery disease, and blood trace elements.

Somatic DNA damage and causative factors (occupational exposures, foods, habits, etc.) are thought to contribute to the pathogenesis of atherosclerosis, although knowledge about their role in coronary artery disease (CAD) is still insufficient. This study aimed to determine the effects of lymphocyte-DNA damage and blood trace element concentrations on CAD. The single-cell alkaline comet was used in the measuring of the lymphocyte DNA damage in blood samples obtained from patients (n = 99) whose CAD grade was determined by the syntax score while the angiographic intervention was carried out. Blood trace element (n = 14) concentrations were monitored by the inductively coupled plasma-optical emission spectroscopy (ICP-OES) after microwave digestion. The relationship between the DNA damage frequencies of the participants and their syntax scores, blood trace element concentrations, and other demographic and clinic parameters were statistically analyzed. Significant correlations were detected between comet data and syntax score (r = 0.858, P < .001), age (r = 0.337, P < .001), blood-urea (r = 0.360, P < .001), creatinine (r = 0.388, P < .001), HbA1c (0.218, P < .05), ECG-QRS time (r = 0.286, P < .01), ECHO-EF (r = -0.377, P < .001), and platelet (r = -0.222, P < .05). The DNA damage frequencies of the groups formed according to their CAD scores were significantly different from the control group (P < .001) and also each other (P ≤ .01). Comet frequencies and CAD grades were found to be correlated with aging (P < .05). DNA damage frequency and syntax score values were significantly (P < .05) higher in males compared to females. Syntax scores were correlated with aging (r = 0.348, P < .01), ECHO-EF (r = 0.374, P < .001), blood-urea (r = 0.398, P < .001), creatinine (r = 0.433, P < .001), glucose (0.218, P < .05), and HbA1c (r = 0.200, P < .05). Significant correlations were observed between trace elements and demographic values, blood parameters, diseases, angio parameters, ECHO, and ECG parameters. It was observed that the concentrations of trace elements detected in the blood were 93.4% correlated with each other. Lymphocyte DNA damage is a strong biomarker for the atherosclerotic indicator of CAD. Aging is an effective factor both in the DNA damage frequency and CAD risk index. Creatinine and urea are factors that have the power to change the CAD risk index and DNA damage frequency. The higher DNA damage and CAD risk were monitored in males compared to females. The relationship between some biomarkers and blood trace element concentrations showed that further studies are needed to more accurately evaluate the relationship between trace elements, DNA damage frequencies, and CAD.

Prognostic significance of the SYNTAX score and SYNTAX score II in patients with myocardial infarction treated with percutaneous coronary intervention.

We aimed to evaluate the prognostic significance of the SYNTAX score (SS) and SYNTAX score II (SS-II) in a contemporary real-world cohort of myocardial infarction (MI) patients treated with percutaneous coronary intervention (PCI). The role of SSand SS-II in the prognostic stratification of patients presenting with MI and undergoing PCI has been poorly investigated. This study included MI patients treated with PCI from January 2015 to April 2020 at the University Hospital of Salerno. Patients were divided into tertiles according to the baseline SS and SS-II values. The primary outcome measure was all-cause mortality at long-term follow-up; secondary outcome measures were cardiovascular (CV) death and MI. Overall, 915 patients were included in this study. Mean SS and SS-II were 16.1 ± 10.0 and 31.6 ± 11.5, respectively. At propensity weighting adjusted Cox regression analysis, both SS (hazard ratio [HR]: 1.02; 95% confidence interval [CI]: 1.02-1.06; p = 0.017) and SS-II (HR: 1.08; 95%CI: 1.07-1.10; p < 0.001) were significantly associated with the risk of all-cause mortality at long-term follow-up; both SS (HR 1.04; CI 1.01-1.06; p < 0.001) and SS-II (HR 1.08; CI 1.06-1.10; p < 0.001) were significantly associated with the risk of CV death, but only SS-II showed a significant association with the risk of recurrent MI (HR 1.03; CI 1.01-1.05; p < 0.001). At 5 years, SS-II showed a significantly higher discriminative ability for all-cause mortality than SS (area under the curve: 0.82 vs. 0.64; p < 0.001). SS-II was able to reclassify the risk of long-term mortality beyond the SS (net reclassification index 0.88; 95%CI: 0.38-1.54; p = 0.033). In a real-world cohort of MI patients treated with PCI, SS-II was a stronger prognostic predictor of long-term mortality than SS.

Predictive value of SYNTAX-Ⅱ score on prognosis of patients with chronic total occlusion undergoing percutaneous coronary intervention

Objective: To investigate the predictive value of SYNTAX-Ⅱ score on long term prognosis of patients diagnosed with chronic total occlusion (CTO) and received percutaneous coronary intervention (PCI). Methods: Patients undergoing CTO-PCI in Fuwai hospital from January 2010 to December 2013 were enrolled in this retrospective analysis. The SYNTAX-Ⅱ score of the patients was calculated. According to SYNTAX-Ⅱ score tertiles, patients were stratified as follows: SYNTAX-Ⅱ≤20, 20<SYNTAX-Ⅱ≤27, SYNTAX-Ⅱ>27. Primary endpoint was major adverse cardiac events (MACCE), including all-cause death, myocardial infarction, stroke and any revascularization. Secondary endpoints included stent thrombosis, heart failure and target lesion failure (TLF). Patients were followed up by outpatient visit or telephone call at 1 month, 6 months and 1 year after PCI, and annually up to 5 years. Multivariate Cox regression model was used to analyze the independent risk factors of all-cause death in patients undergoing CTO-PCI. The predictive value of SYNTAX score with SYNTAX-Ⅱ score for all-cause death was evaluated by the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results: A total of 2 391 patients with CTO and received PCI were enrolled in this study. The mean age was (57.0±10.5) years, 1 994 (83.40%) patients were male. There were 802 patients in lower tertile group (SYNTAX-Ⅱ≤20), 798 patients in intermediate group (20<SYNTAX-Ⅱ≤27) and 791 patients in upper tertile group (SYNTAX-Ⅱ>27). At the end of 5-year follow-up, the loss to follow-up rate of the three groups was 9.10%(73/802), 10.78%(86/798)and 8.85%(70/791), respectively. The rate of all-cause mortality (1.78% (13/729) vs. 3.65% (26/712) vs. 9.02% (65/721), P<0.001), cardiac death (1.37% (10/729) vs. 2.11% (15/712) vs. 4.85% (35/721), P<0.001), target vessel myocardial infarctions (4.25% (31/729) vs. 4.49% (32/712) vs. 7.07% (51/721), P=0.03), probable stent thrombosis (1.51% (11/729) vs. 2.81% (20/712) vs. 3.61% (26/721), P=0.04) and heart failure (1.78% (13/729) vs. 1.97% (14/712) vs. 5.41% (39/721), P<0.001) increased in proportion to increasing SYNTAX-Ⅱ score (all P<0.05). Multivariable Cox regression analysis indicated that female (HR=2.05, 95%CI 1.12-3.73, P=0.01), left ventricular ejection fraction (HR=0.97, 95%CI 0.95-1.00, P=0.05) and SYNTAX-Ⅱ score (HR=1.07, 95%CI 1.02-1.11,P=0.01) were independent predictors for all-cause mortality in patients undergoing CTO-PCI. The predicted value of the SYNTAX-Ⅱ score for all-cause death was significantly higher than the SYNTAX score (AUC 0.71 vs. 0.60, P=0.003). Conclusion: For CTO patients who underwent percutaneous coronary intervention, SYNTAX-Ⅱ score is an independent predictor for 5-year all-cause death, and SYNTAX-Ⅱ serves as an important predictor for all-cause death in these patients.

Prognostic value of syntax score, intravascular ultrasound and near-infrared spectroscopy to identify low-risk patients with coronary artery disease 5-year results from the ATHEROREMO and IBIS-3 cohorts.

The prognostic value of SYNTAX score (SS), intravascular ultrasound (IVUS)-derived plaque burden (PB) and near-infrared spectroscopy (NIRS)-derived lipid core burden index(LCBI) for identification of high-risk patients for major adverse cardiovascular events (MACE) has been proven in previous studies. The majority of patients presenting in the cathlab however do not endure MACE over time, and identification of low-risk groups has remained underexposed. This study evaluates the combined prognostic value of SS, PB and LCBI in identifying patients with low MACE risk. This post-hoc analysis combines the ATHEROREMO and IBIS-3 studies and included 798 patients undergoing coronary angiography. Anatomical SS was calculated (N = 617) and ≥40mm non-stenotic segment of a non-target vessel was investigated with IVUS (N = 645) and NIRS (N = 273) to determine PB and maximum 4mm LCBI (LCBI4mm). During five-year follow-up, 191 MACE were observed. Patients with PB ≤70%, LCBI4mm ≤227 (median), or SS ≤8 (median) had lower MACE incidence than their counterparts with higher values. Combined into one model, LCBI4mm ≤227 (adjusted hazard ratio [aHR] 0.49, 95% confidence interval [CI] 0.30-0.78; p-value = 0.003) and SS ≤8 (aHR 0.67, 95%CI 0.48-0.96, p-value = 0.027) were independently associated with (lower) MACE rate, but PB was not. Additionally, negative predictive value (NPV) of this model was high (SS&lt;8: 0.80, PB&lt;70%: 0.77, LCBI4mm&lt;227: 0.79). In this cohort, SS and LCBI4mm proved to be independent predictors of MACE-free survival during five-year follow-up. Combination of SS and LCBI4mm is useful to identify a low-risk population. Furthermore, NPV of SS, PB and LCBI4mm for prediction of MACE is high.

P192 LONG TERM PROGNOSTIC EFFECT OF LIPROTEIN(A) IN PATIENTS WITH AND WITHOUT DIABETES MELLITUS AFTER MYOCARDIAL INFARCTION

Abstract Aims 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 lipoprotein(a) [Lp(a)] serum level on long–term outcome in this very high–risk population. Methods This was a retrospective, single–center, study including consecutive patients admitted with MI diagnosis between January 1, 2017, and December 31, 2020. The availability of data on baseline Lp(a) 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 Lp(a) value of 50 mg/dL was used to test the hypothesis of a different effect of Lp(a) on the clinical outcome of patients with or without DM. The primary study outcome was all–cause death at 3–year follow–up. Results 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 dyslipidemia, 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 Lp(a)≥50 mg/dL showed a significantly lower long–term survival compared with those with Lp(a)&amp;lt;50 mg/dL (Log–Rank=0.004). In DM patients DM, conversely, no survival difference was found between patients with Lp(a)≥50 mg/dL vs. those with Lp(a)&amp;lt;50 mg/dL. At multivariable Cox regression analysis, in patients without DM, Lp(a) 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). Conclusion In this MI population, Lp(a) was independently associated with long–term mortality in patients without DM, but not in patients with DM. Whether DM can modify the effect of Lp(a) on clinical outcome after MI requires confirmation by larger prospective studies.

The SYNTAX score and the coronary artery calcium score for the prediction of clinical outcomes in patients undergoing percutaneous coronary intervention

This study aims to investigate the predictive value of SYNTAX score,SYNTAX score II and coronary artery calcium score on the prognosis of patients after PCI. The SYNTAX score, SYNTAX score II and coronary artery calcium score were calculated. The primary end point was major adverse cardiac and cerebrovascular events (MACCE). 195 patients were included, 182 patients were followed up and the median follow-up time was 34.5 months. The MACCE occurred in 30 patients. The incidence of MACCE of lower risk, medium risk and high risk were: SYNTAX score: 6.7%, 18.3%, 24.2%; coronary artery calcium score: 9.7%, 18.3%, 21.7%; SYNTAX score II: 6.6%, 16.4%, 26.7%; new combined risk score: 7.7%, 8.1%, and 35.8%. ROC analysis showed that SYNTAX score (AUC: 0.641, 95%CI: 0.540-0.743), coronary artery calcium score (AUC: 0.597, 95%CI: 0.490 -0.704), SYNTAX score II (AUC: 0.662, 95%CI: 0.561 - 0.763), new combined risk score (0.711, 95%CI: 0.606 - 0.816). The new combined risk score tended to be superior compared to other risk score (p<0.01). The results suggested that SYNTAX score, SYNTAX score II and new combined risk score can predict the occurrence of MACCE after PCI, new combined risk score provides superior prediction.

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.

SYNTAX and Coronary Artery Calcium Score Predict Atherosclerotic Plaque Formation in the Ascending Aorta.

There is no study about the relationship between the complexity of coronary artery disease (SYNTAX SCORE; SS), and coronary artery calcium (CAC) score, accompanied with aortic calcium score (ACS) levels. The objective of this study was to investigate the relationship between the preoperative SS and CAC scores accompanying ACS in isolated CABG patients and their postoperative clinical results. This study included 130 consecutive CABG patients. The mean age of the patients was 62.3 ± 8.62 years (range: 47-84 years). SS was measured using coronary angiography by an experienced cardiologist. We investigated the ACS accompanied with CAC scores using a multidetector computed tomography (MDCT) in the same session, preoperatively. Measurements of the CAC score and ACS were measured by an experienced radiologist, who was unaware of the study in the same session. In order to investigate aortic wall pathology in patients with positive aortic calcification, we provided aortic tissue samples prior to the proximal anastomosis of bypass grafts using No:11 scalpel. Overall median SS was 39 ± 7.2 (range: 15-41). CAC score was zero in 34 patients (26.1%). For the patients with a CAC score of zero, the median SS was 32 ± 9.4. There was no evidence of aortic calcification or plaque formation in 62 patients (47.6%). In these patients, the median SS was 35.6 ± 11.3. No significant difference was found when both groups were compared and for those patients with a calcific score of zero (P = .85). The median CAC score and ACS were 238 ± 122 AU (range: 0-1238 AU) and 112 ± 40 AU (range: 0-730 AU), respectively (P = .0033). For patients with a CAC score and ACS ≥400 AU, the mean SYNTAX score was ≥ 37. SS was correlated with CAC score (R:0.585; P < .0001). SYNTAX was correlated with ACS (R:0.557; P < .001). In multivariate analysis of SS (OR 1.053, 95% CI: 1.003-1.106, P = .039), gender (OR 0.189, 95% CI: 0.053-0.678, P = 0.011), age (OR 1.454, 95% CI: 1.256-1.632, P = .012), and diabetes mellitus (OR 0.341, 95% CI: 1.006-1.124, P = .014) were independent predictors for CAC score and aortic calcification. CAC score and ACS are strongly correlated with the complexity of coronary arteries in CABG patients. The total CAC score (≥ 400 AU) was independently associated with the degree of SS (>37). To prevent MACCE and mortality in CABG patients, we suggest the measurement of CAC score accompanied with ACS using MDCT as a non-invasive method. Highlight points: • Atherosclerotic plaque formation in aorta and coronary arteries are the main risk factors for stroke and infarction in CABG operations. •SYNTAX score value and aortic atherosclerosis levels are directly correlated. •SYNTAX score may predict the complications due to atherosclerosis during heart surgery.

Comparison of the prognostic value of SYNTAX score and clinical SYNTAX score on outcomes of Chinese patients underwent percutaneous coronary intervention

BackgroundPrevious studies have validated the capability of SYNTAX score (SS) and clinical SYNTAX score (CSS) in the prediction of clinical outcomes in patients who have undergone PCI; however, studies on comparison of these two scoring systems in Chinese population have been sparse.MethodsTo study the ability of SS and CSS in prediction of clinical outcomes of Chinese patients underwent percutaneous coronary intervention (PCI). We retrospectively calculated SS and CSS for 547 Chinese patients from a single center who underwent PCI. Patients were stratified into tertiles according to their SS and CSS. We compared the 2-year clinical outcomes in these patients stratified separately by SS and CSS tertiles.ResultsThe incidence of major adverse cardiac and cerebro-vascular events (MACCE) was the highest in patients with SSHIGH (13.5%), comparing to 6.8% in SSMED and 0% in SSLOW (p < 0.0001). The Cox multivariable analysis showed that the SS and CSS were both strong independent predictors for MACCE [1.100 (1.069–1.133), 1.017 (1.010–1.025), both p < 0.0001]. The receiver operating characteristic (ROC) curves showed the areas-under-the-curves for all-cause death by CSS was slightly larger comparing to SS but not significantly (AUC SS, 0.64; AUC CSS, 0.71; p = 0.23).ConclusionWe concluded that both the SS and CSS were capable of risk stratification of clinical outcomes in all-comers population as well as in low and moderate risk Chinese patients undergoing PCI with CSS showing slightly better advantage.

Prognostic Utility of Culprit SYNTAX Score in Patients With Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction

A higher SYNTAX score (SS) is strongly associated with poor prognosis in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (CS-STEMI). However, the predictive value of culprit-lesion SYNTAX score (cul-SS) and SS has not been compared although the culprit-lesion-only primary percutaneous coronary intervention (PCI) strategy showed improved long-term survival recently. This study compared the predictive utility of cul-SS and SS for in-hospital mortality among the patients with CS-STEMI from during 2010-2019. Of the 215 patients, 79 (37%) died. SS ≥22, cul-SS ≥11, final thrombolysis in myocardial infarction (TIMI) flow ≤2, and no-reflow phenomenon were associated with in-hospital mortality. In patients with multi-vessel disease, the nonsurvivors with cul-SS ≥11 had a higher mortality rate than the survivors (75.0% vs. 44.9%, p = 0.001), whereas the SS ≥22 showed no significant difference. The cul-SS ≥11 revealed only an independent factor in the multivariate analysis (OR 2.6, p = 0.010). the AUC of cul-SS ≥11 for in-hospital mortality was modest (0.617 p < 0.05), which might be augmented up to 0.745 (p < 0.001) by the combination with TIMI flow ≤2, no-reflow phenomenon, and blood total CO2 content <15 mEq/L. The cul-SS might be more predictive than SS for in-hospital mortality in our patients with CS-STEMI.

Predictive value of the SYNTAX score for diabetic retinopathy in stable coronary artery disease patients with a concomitant type 2 diabetes mellitus

AimsDiabetic retinopathy (DR) is a serious complication of type 2 diabetes mellitus (T2DM) and is the most common cause of impaired vision for adults. DR is related to a number of risk factors. The aim of this study was to investigate the relationship between burden of coronary artery disease assessed by Syntax Score (SS) and DR in T2DM. MethodsA total of 96 T2DM patients undergoing coronary angiography were prospectively included in the study. Presence and severity of DR were assessed by ocular fundus examination. DR was graded as no apparent retinopathy (NDR), non-proliferative (NPDR), and proliferative DR (PDR). The SS for each patient was calculated. ResultsThe mean age was 58.0 ± 8.2 years. SS gradually increased from NDR group to PDR group. The median (IQR) value of SS was 10 (5–16) in patients with NDR, 22.8 (17–35.8) in those with NPDR, and 35.5 (28–37) in those with PDR (p < 0.001). On multivariate analysis SS [odds ratio (OR) 1.145, p = 0.001] and duration of diabetes (OR 1.753, p = 0.031) were independent factors for DR. ConclusionsThe SS is independently associated with the occurrence of DR in T2DM. Ophthalmologists and cardiologists must cooperate when evaluating patients with DM because of possible complications.

Prognostic value of SYNTAX score and SYNTAX score II in an 'all-comers' population treated with angoplasty.

The SYNTAX score and SYNTAX score II have a high predictive capacity for adverse cardiovascular events. We aimed to demonstrate that both scores were good predictors of long-term adverse outcomes in an 'all-comers' population treated with a percutaneous coronary intervention (PCI). In the study, we included 785 patients who received an angioplasty at our center between January 2011 and December 2012. The patients were distributed in tertiles according to the SYNTAX score and SYNTAX score II values; for the SYNTAX score - low ≤6.5 (n = 225); mid >6.5, <11.5 (n = 229); high ≥11.5 (n = 221); and for the SYNTAX score II PCI: low ≤20.5 (n = 226); mid >20.5, < 29.6 (n = 221); and high ≥29.6 (n = 218). The rates of major adverse cardiovascular events, death, cardiac death and new revascularizations at 3 years were significantly higher in the highest tertile of both the scores. For SYNTAX score: major adverse cardiovascular events, 12-15.3-21.7%, P < 0.001; death, 7.6-8.3-14%, P = 0.04; cardiac death, 3.2-2.7-7.5%, P = 0.03; new revascularizations, 4.5-8.6-10.4%, P = 0.001. For SYNTAX score II PCI: major adverse cardiovascular events, 8-10.9-28.9%, P < 0.001; death, 3.1-3.6-21.5%, P < 0.001; cardiac death, 0.9-0.5-11.4%, P < 0.001; new revascularizations, 4.5-8.2-11.3%, P = 0.03. The SYNTAX score II showed better predictive capacity than the SYNTAX score for major adverse cardiovascular events, death and cardiac death, with no difference noted for new revascularizations, and it was an independent predictor for these events in an 'all-comers' population.

Paraoxonase 1 low activity and SYNTAX score may predict postoperative complications after coronary artery surgery.

Coronary artery bypass grafting (CABG) seems to present a powerful trigger of oxidative stress (OS) and acute inflammatory response. This study aimed to estimate the effects of off-pump coronary artery bypass (OPCAB) grafting on the OS that is commonly observed in patients undergoing operation under cardiopulmonary bypass (CPB). Additionally, we aimed to examine the relationship between and paraoxonase 1 (PON1) activity and the degree of stenosis, severity and complexity of the atherosclerotic lesions, estimated by SYNTAX score (SS). Study group of 107 patients scheduled for CABG were divided into CPB and OPCAB group. Blood samples for OS markers measurement were collected at six-time intervals: before skin incision (t1), immediately after surgery (t2), 6h (t3), 24h (t4), 48h (t5) and 96h after cessation of the operation and surgical trauma (t6). SS was calculated. A significant decrease in lipid hydroperoxides (LOOH) and advanced oxidation protein products (AOPP) levels after both types of surgeries were observed, whereas PON1 reduction was observed higher in the CPB than in the OPCAB group. A significant inverse correlation between SS values and PON1 activity, preoperatively and during the early postoperative hours after surgery [in t2, t3 time intervals (p<0.05 for all)] was found. ROC analysis showed that for CPB patients, Model with all OS parameters showed excellent accuracy (AUC=0.957, p<0.001) for prediction postoperative complications. Decrease in PON1 activity during the early post-operative phases was related to higher SS. This relationship was more convincing in CPB, compared with OPCAB patients. Moreover, integrated models of OS status parameters have the capability to predict the development of postoperative complications.

Neutrophil-lymphocyte ratio and severity of atherosclerotic disease in stable coronary artery patients with chronic total occlusion

Aim: Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that correlates with coronary artery disease. The Syntax score is an angiographic tool used in grading the complexity of coronary artery disease (CAD). The aim of this study is that NLR is associated with a greater CAD complexity in patients with stable angina pectoris with chronic total occlusion.Materials and Methods: A total of 495 patients who underwent coronary angiography and who had stable angina pectoris with chronic total occlusion in at least 1 vessel were included in the study. The syntax score was used to determine coronary complexity.Results: Patients with CAD were evaluated by grouping according to 2 different criteria as pointed in the European Society of Cardiology (ESC) revascularization guide. When the syntax S is divided into 3 groups (Syntax score 1-22, 23-32,> 32) according to their score values, or 2 groups (Syntax score 1-21 and> 22 or 1-31 and> 31) according to their Syntax score values, NLR was higher in high Syntax score groups than in low groups (p 32) or 2 groups according to Syntax score values (Syntax score 1-21 and >22 or 1-31 and >31) as pointed in ESC revascularization guideline, high Syntax score group having a higher NLR than low group (p0.05). However, when the patients were divided into 3 groups according to the Syntax score, it was seen that there was no statistical difference in terms of NLR values between the high group and the middle group or the middle group and the low group of the Syntax score.Conclusion: In this study, it has been demonstrated that NLR can be used for the determination of the complexity of the disease in patients with stable angina pectoris with chronic total occlusion. However, in determining the degree of complexity in the patients with stable angina, discrimination of the patients close to each other may not be sufficient.

NON-ST ELEVATION MYOCARDIAL INFARCTION: CORRELATION OF RED BLOOD CELL DISTRIBUTION WIDTH WITH SYNTAX SCORE

Objective: To determine the correlation between mean RDW values and mean SYNTAX scores in patients of non ST elevation myocardial infarction. Methodology: This descriptive study was conducted at adult Angiography Department of Faisalabad Institute of Cardiology, Faisalabad from September, 2017 to October, 2018. A total of 130 patients were enrolled in this study. Patients were divided into high (n=89) and low (n=41) SYNTAX groups. The high SYNTAX group was defined as patients with value in the third tertile (SYNTAX score, SX score ≥ 33) while the group with low SNTAX score was defined as patients with values in the lower 2 tertiles (SYNTAX score, SX score &lt; 33). The high RDW group was defined as patients with RDW value &gt; 16 % and the low RDW group as those with RDW value &lt; 16 %. Results: The mean RDW value was correlated with mean SYNTAX score in both groups. The RDW levels were significantly high in patients with high SNTAX score than those with low SYNTAX score (16.2± 1.8 vs. 14.2 ± 1.2, p &lt;0.001). Pearson’s coefficient was used to determine the correlation between RDW levels and SYNTAX scores. There was a significant positive correlation between mean RDW value and mean SYNTAX score value (r=0.831, p &lt;0.001). Conclusion: We found a positive and significant correlation between mean RDW values and mean SYNTAX scores in patients of non-ST elevation myocardial infarction. This reflects the utility of RDW being a non-invasive and readily available laboratory test to determine the severity and complexity of coronary disease in these patients.