Clinical SYNTAX Score – a good predictor for renal artery stenosis in acute myocardial infarction patients: analysis from the REN-ACS trial

Abstract

A b s t r a c tIntroduction: In ST-elevation myocardial infarction (STEMI) patients, multisite artery disease represents a serious issue influencing evolution, outcomes and prognosis. We evaluated for the first time the power of the Myocardial Infarction SYNTAX Score (MI SS) and Clinical SYNTAX Score (MI CSS) as predictors for renal artery stenosis (RAS) in STEMI. We also stratified the study population according to the two scores, and identified the variables correlated with the higher score. Material and methods: We used data from the REN-ACS study, which included 181 consecutive patients prospectively investigated for presence of RAS (through renal angiography), arterial stiffness (carotid-femoral pulse wave velocity, cf-PWV) and hydration status (bioimpedance). MI SS and CSS were computed. Results: Multivariate regressions indicated that the independent variables correlated with MI SS were left ventricular ejection fraction < 40%, significant RAS (> 50%, defined as RAS+), history of heart failure, and multivascular coronary disease (CAD, p < 0.03 for each), while those correlated with MI CSS were RAS+, cf-PWV, history of CAD, multivascular CAD, cholesterol, and total body water (p < 0.02 for each). In order to evaluate the ability to predict RAS+ we generated receiver operating characteristics and areas under curves, and the Youden index for MI SS and CSS. Conclusions: Both scores correlated with extensive atherosclerotic disease and presence of RAS+. A lower CSS proved to be a good predictor for exclusion of RAS+, with high specificity (85%) and negative predictive value (92%), and fair sensitivity (60%). We aim to further pursue this line of research and design a better predictor for RAS, with the inclusion of a novel biomarker in order to increase sensitivity.

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“…Through the advent of modern antithrombotic therapy 2 , secondary prevention, and percutaneous coronary intervention (PCI) 3,4 , there has been a decrease in acute and long-term mortality due to cardiac causes; however, the one-year mortality due to ST segment elevation myocardial infarction (STEMI) is approximately 10% 5 . Thus, early risk stratification management has been utilized, and many risk predictive indicators have been applied to predict the short- and long-term prognosis of patients with AMI 6,7 .…”

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“…These predictors seem to be mostly preponderant. However, several other periprocedural indices related to technical aspects and maneuvers appear to be at least similarly influential for outcomes after coronary artery bypass graft interventions [6][7][8][9].…”

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“…e introduction of SYNTAX I and II scores [9], SYNTAX functional score [10] (based on coronary flow reserve), and Clinical SYNTAX score pointed out that it is a difficult task for a professional to decide/recommend a therapy on him/her individual own [11]. Moreover, recent studies suggested that intraobserver and interobserver variability when interpreting a coronary angiogram often results in inappropriate revascularization strategies [12][13][14].…”