Abstract 13485: Value of the SYNTAX Score in Patients Treated by Primary Percutaneous Coronary Intervention for Acute ST Elevation Myocardial Infarction — the MI SYNTAXscore Study
Aims To evaluate the SYNTAX score (SXscore) calculated at two stages during a primary percutaneous intervention (PPCI), i.e., SXscore I (diagnostic), SXscore II (post wiring) and assesses its additional value to standard clinical risk scores in acute myocardial infarction.
Methods and Results: SXscores I and II were applied to 736 consecutive acute STEMI patients referred for PPCI between November 2006 and February 2008. . SXscore changed significantly before — I = 16 (IQR: 9.5–23) and after wiring- II =11 (IQR: 6–19), p < 0.001. 99% of stents implanted were DES. Kaplan Meier methods were used to compare the primary end point MACE (composite of repeat MI, TVR and mortality) and secondary endpoint mortality at 1.5 years in tertiles of SXscore I and SXscore II. MACE was highest in the higher SXscore I tertile (11% vs.15% vs 23%, log rank <0.01), driven primarily by increased rate of mortality (9% vs. 11% vs. 17%, log rank = 0.02). MACE was also highest in SXscore II tertile, by a combination of increased mortality but also TVR (TVR rate : 2% vs. 3% vs. 9%, log rank <0.01). Predictive cox regression models for mortality and for MACE were significantly and similarly improved by addition of either SXscore I or SXscore II (HR 1.63, 95%CI 1.18–2.26, p <0.01 for MACE). Classification tree analysis identified SXscore I 31 for long term mortality and SXscore II 13.5 for long term MACE as the best cut-offs for the respective endpoints.
Conclusions: SXscore during PPCI is a useful tool that provides additional risk stratification to known risk factors of long term mortality and MACE in patients with STEMI.
- © 2010 by American Heart Association, Inc.