Abstract 13777: The MI SYNTAXscore Is A Predictor Of ‘No Reflow’ In Patients Treated With Primary Percutaneous Coronary Intervention For ST Segment Elevation Myocardial Infarction
Background: The no-reflow phenomenon has a significant effect on clinical outcome in patients with acute ST segment elevation myocardial infarction (STEMI). Angiographic features incorporated in the SYNTAXscore (SXscore) obtained on a diagnostic angiogram during primary percutaneous coronary intervention (such as the patency of the infarct related artery, the myocardium subtended at the culprit lesion, presence of multi-vessel disease as well as complexity of the lesions including chronic total occlusions, bifurcation lesions, long lesions) may be associated with the occurrence of myocardial no-reflow.
Aim: To assess the ability of the SXscore obtained on diagnostic angiography to predict no-reflow during PPCI
Methods SXscore was applied to 736 consecutive patients presenting with STEMI between November 2006 and February 2008. No-reflow was defined as occurrance of at least one of : final TIMI flow grade <3; final Myocardial blush grade <2; epicardial coronary no-reflow ie a decrease in TIMI flow to 0/1 after establishing TIMI2/3 flow; distal coronary occlusion; and a final corrected TIMI frame count of >100 fps.
Results The median SXscore was 16 (9.5-23). Patients with a high SXscore (>20) were more commonly older, had more often diabetes type 2, were current smokers, had a family history of coronary artery disease and a history of previous myocardial infarction. Patients with high SXscore also more often presented with higher pulse rates and cardiogenic shock. TIMI 0/1 flow was more often present in the patients with high SXscore (>20) and left main disease, and 3 vessel disease and chronic total occlusions were more often present in higher scores. On univariate logistic regression analysis the SXscore showed strong association with odds ratio (OR) of 1.04, 95% CI (1.02-1.06), p < 0.001 for every unit increase in the score. Furthermore, multivariate logistic regression in a model including TIMI risk variables, SX score was an independent predictor on no-reflow: (OR); 1.10 95%CI 1.04-1.16), p <0.001.
Conclusion. The SXscore can identify patients at risk of developing no-reflow. Periprocedural pharmacological or mechanical preventive measures of no-reflow may in the future be directed at those at higher risk as identified by the SXscore.
- © 2011 by American Heart Association, Inc.