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

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