Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

Abstract

This study evaluated additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). All six scores were calculated in 209 consecutive STEMI patients undergoing pPCI. Primary end-point was the major adverse cardiovascular event (MACE--composite of cardiovascular mortality, non-fatal myocardial infarction and stroke); secondary end point was cardiovascular mortality. Patients were stratified according to the SYNTAX score tertiles (≤12; between 12 and 19.5; >19.5). The median follow-up was 20 months. Rates of MACE and cardiovascular mortality were highest in the upper tertile of the SYNTAX score (p < 0.001 and p = 0.003, respectively). SYNTAX score was independent multivariable predictor of MACE and cardiovascular mortality when added to GRACE, TIMI, ZWOLLE, and PAMI risk scores. However, the SYNTAX score did not improve the Cox regression models of MACE and cardiovascular mortality when added to the CADILLAC score. The SYNTAX score has predictive value for MACE and cardiovascular mortality in patients with STEMI undergoing primary PCI. Furthermore, SYNTAX score improves prognostic performance of well-established GRACE, TIMI, ZWOLLE and PAMI clinical scores, but not the CADILLAC risk score. Therefore, long-term survival in patients after STEMI depends less on detailed angiographical characterization of coronary lesions, but more on clinical characteristics, myocardial function and basic angiographic findings as provided by the CADILLAC score.

Prognostic impact of baseline and residual SYNTAX scores in cardiogenic shock

“…In the present study, bSS had some additive predictive value over the GRACE and IABP‐SHOCK II risk scores. Previously, in a non‐CS STEMI population, bSS was shown to be useful in risk stratification over GRACE risk score . Nevertheless, we believe, that in the acute clinical context of CS, using clinical risk scores for risk stratification is more feasible and accurate than assessing the exact burden of coronary artery disease with bSS.…”

Neutrophil to lymphocyte ratio predicts short- and long-term mortality following revascularization therapy for ST elevation myocardial infarction

“…TIMI-STEMI risk score). Multiple ACS studies now support the use of NLR as an admission biomarker, which can be used to determine prognosis [25,26]. NLR can be readily calculated at point of care, thereby facilitating short-and long-term risk prediction for STEMI patients, even prior to revascularization.…”

“…For instance, the overwhelmingly poor short-and long-term predicted mortality of certain STEMI patients, might preclude invasive intervention, and mandate more conservative management strategies. Interestingly, more complicated risk scoring systems that incorporate more comprehensive angiographic parameters and/or presentation hemodynamic variables, do not necessarily improve the long-term prediction of all-cause mortality [26]. Furthermore, the clinical variables used in risk prediction models vary in predictive risk assessment capacity according to the time point being considered post-MI [29,30].…”

Cardiovascular imaging 2013 in the International Journal of Cardiovascular Imaging

“…Brkovic in the team of Beleslin [5] investigated the possible additive prognostic value of the SYNTAX score over other existing scores in patients with STEMI undergoing primary PCI. This retrospective observational study included 209 consecutive patients with STEMI referred for primary PCI.…”