Role of the SYNTAX score in assessing the outcomes of percutaneous interventions in patients with ST segment elevation myocardial infarction

Tarasov R.S., Ganyukov V.I., Barbarash O.L., Barbarash L.S.

Department of Multifocal Atherosclerosis, Scientific Research Institute for Complex Problems of Cardiovascular Diseases under the Siberian Branch of the Russian Academy of Medical Sciences, Kemerovo, Russia

Based on the findings of a single-centre study of 327 patients presenting with ST segment elevation myocardial infarction (STEMI) subjected to primary percutaneous coronary intervention (PCI) we examined the prognostic role of severity of atherosclerotic multivascular lesion (ML) of the coronary bed. The patients were subdivided into three groups depending on the quantitative index assessing severity of coronary atherosclerosis in points with the help of the SYNTAX scale. Group One was composed of 207 patients with the SYNTAX score ≤22 points (moderate lesion), Group Two comprised 89 patients with severe coronary atherosclerosis and the SYNTAX equalling 23–32 points, whereas 31 patients were included into Group Three with extremely severe lesion and the SYNTAX score >32 points. During 30 days and 12 months of follow up we assessed the effect of severity of coronary atherosclerosis on the outcomes of myocardial revascularization. The end points of the study were such unfavourable cardiovascular events as death, recurrent myocardial infarction (MI), secondary unplanned revascularization (SUR) of coronary arteries and in-stent thrombosis (IST). We obtained the findings suggesting that severity of the lesion of the coronary bed according to the SYNTAX scale >23 is associated with a decrease in the global myocardial contractility, increased incidence of postinfarction cardiosclerosis (PICS) and more pronounced manifestation of acute left ventricular insufficiency as compared to patients with moderately pronounced coronary atherosclerosis (SYNTAX <23 points). Characteristic features of patients with severe and utterly severe atherosclerotic lesions of the coronary bed were three-vessel lesions and a trend towards a decrease in the incidence rate of success of the primary PCI as compared with patients having moderate severity of coronary atherosclerosis. The prognostic significance of the SYNTAX score was evidenced both at the stage of the 30-day and 12-month period of follow up, which manifested itself in a considerable increase of frequency of fatal outcomes, in-stent thrombosis and the composite end point amongst patients with severity of the coronary bed lesion by the SYNTAX score >23 points. Thus, the SYNTAX scale developed and adapted for optimal choice of the method of revascularization in patients with stable coronary artery disease (CAD) may successfully be used for stratification of the risk and search for optimal strategies of treatment also amongst patients with STEMI in multivascular lesions of the coronary bed, subjected to urgent revascularization with the help of primary PCI.

KEY WORDS: myocardial infarction, primary PCI, SYNTAX score, severity of coronary atherosclerosis, multivascular lesion.

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