Usefulness of updated logistic clinical SYNTAX score based on MI‐SYNTAX score in patients with ST‐elevation myocardial infarction

Abstract

Objectives To compare the predictive performances of the prewiring, postwiring MI‐SYNTAX scores, prewiring, and postwiring Updated Logistic Clinical SYNTAX score (LCSS) for 2‐year all‐cause mortality post percutaneous coronary intervention (PCI) in ST‐elevation myocardial infarction (STEMI) patients. Background In patients with STEMI and undergoing primary PCI, coronary stenosis(es) distal to the culprit lesion is often observed after the restoration of coronary flow. To address comprehensively the complex coronary anatomy in these patients, prewiring and postwiring MI‐SYNTAX scores have been reported in the literature. Furthermore, to enable individualized risk estimation for long‐term all‐cause mortality, the Updated LCSS has been developed by combining the anatomical SYNTAX score and clinical factors. Methods In the randomized GLOBAL LEADERS trial, anatomical SYNTAX score analysis was performed by an independent angiographic corelab for the first 4,000 consecutive patients as a prespecified analysis; of these, 545 presented with STEMI. The efficacy of the mortality predictions of the four scores at 2 years were evaluated based on their discrimination and calibration abilities. Results Complete data was available in 512 patients (93.9%). When the patients were stratified into two groups based on the median of the scores, the prewiring and postwiring Updated LCSSs demonstrated that the high‐score groups were associated with higher rates of 2‐year all‐cause mortality compared to the low‐score groups (6.6 vs. 1.2%; log‐rank p = .001 and 6.6 vs. 1.2%; log‐rank p = .001, respectively). There were no statistically significant differences for predicting the mortality between the prewiring (area under the curve [AUC] 0.625), postwiring MI‐SYNTAX score (AUC 0.614), prewiring (AUC 0.755), and postwiring Updated LCSS (AUC 0.757). In the integrated discrimination improvement (IDI), the prewiring MI‐SYNTAX score had a better discrimination for the mortality than the postwiring MI‐SYNTAX score (IDI ‐0.0082; p = .029). The four scores had acceptable calibration abilities for 2‐year all‐cause mortality. Conclusions The prewiring Updated LCSS predicts long‐term all‐cause mortality with clearly useful discrimination and acceptable calibration. Since the postwiring MI‐SYNTAX score does not improve mortality prediction, the prewiring MI‐SYNTAX score may be preferred for the 2‐year mortality prediction using the Updated LCSS.

External validation of the GRACE risk score 2.0 in the contemporary all‐comers GLOBAL LEADERS trial

“…For better risk stratification in the contemporary ACS population, recalibration or a novel dedicated risk score might be required 21,22 . Among patients presenting with STEMI, the prewiring MI‐SYNTAX score may be more useful for the risk stratification, suggested by another subgroup analysis of the GLOBAL LEADERS trial 23 …”

“…21,22 Among patients presenting with STEMI, the prewiring MI-SYNTAX score may be more useful for the risk stratification, suggested by another subgroup analysis of the GLOBAL LEADERS trial. 23…”

The Clinical Value of Syntax Scores in Predicting Coronary Artery Disease Outcomes

“…The modified SS can aid in the optimization of predilation, scaffold/ stent sizing, and postdilation procedures [37]. According to Kawashima et al [38], the prewiring updated logistic clinical SS is more accurate than the postwiring SS. SS-II predicts major adverse events and cardiac death more successfully [39].…”

<b>Application of SYNTAX and its Derivative Scores in the Selection of Revascularization Strategies for Complex Coronary Heart Disease</b>

“…With the improvement of revascularization technology, the expansion of surgical indications for percutaneous coronary intervention (PCI), and the revision of coronary lesion risk stratification scores, revascularization vessel diseases found that the clinical SYNTAX score was superior to the anatomical SYNTAX score in predicting the occurrence of long-term adverse events after CABG for complex CAD, but the study also found a deficiency of the low-to-moderate level clinical SYNTAX score in assessing the long-term prognosis of complex CHD treated with different revascularization regimens [20] . To address these limitations, researchers conducted a 2-year follow-up study in 512 STEMI patients, proposed the Logistic Clinical SYNTAX score (LCSS) concept, and concluded that the LCSS has significant discrimination and acceptable calibration in predicting all-cause mortality [21] . Furthermore, it has been demonstrated through continuous improvement of SYNTAX-derived scores and subsequent studies that the clinical SYNTAX score has better predictive performance than the residual SYNTAX score for all-cause mortality 2 years after revascularization for complex CAD, whereas its predictive power for revascularization is the opposite [22] .…”