CLINICAL SYNTAX SCORE FOR RISK STRATIFICATION AFTER ACUTE MYOCARDIAL INFARCTION Authors: Somkereki Cristina, Dr. Hadadi L. Coordinator: Prof. Dr. Dobreanu D.

Background Primary percutaneous coronary intervention (pPCI) – recommended treatment of STEMI; Clinical SYNTAX Score (CSS): a combined risk model integrating angiographic (SYNTAX Score) and 3 clinical variables; a validated tool for post-PCI risk prediction in stable coronary artery disease patients; CSS- has never been studied prospectively in the context of STEMI;

Objective to test and compare the predictive power of SYNTAX Score (SXS) and CSS for in-hospital mortality in a population of STEMI patients treated with pPCI ;

Material and methods Prospective clinical study during a one-year period Inclusion criteria: acute ischemic chest pain lasting at least 30 minutes; minimum 1 mm ST segment elevation in at least two contiguous electrocardiographic leads; primary PCI as reperfusion therapy performed within the first 12 hours or within 12-24 hours after symptom onset if ischemia still present Exclusion criteria: previous coronary artery by-pass surgery, thrombolytic therapy before PCI confounding electrocardiogram (left bundle branch block, paced rhythm, pre-excitation syndrome, major left ventricular hypertrophy), patient’s refusal for participating in the study

The SYNTAX score algorithm 1.Dominance 2.Number of lesions 3.Segments involved per lesion Lesion characteristics: 4.Total occlusion (number of segments involved; age of total occlusion; blunt stump; bridging collaterals; first segment beyond the occlusion visible by antegrade or retrograde filling; side branch involvement) 5.Trifurcation(number of segments diseased) 6.Bifurcation 7.Aorto-ostial lesion 8.Severe tortuosity 9.Length >20 mm 10.Heavy calcification 11.Thrombus 12.Diffuse disease/small vessels

Clinical SYNTAX Score CSS=[SYNTAX Score]*[modified ACEF score]. CSS was calculated for each patient using the formulas: CSS=[SYNTAX Score]*[modified ACEF score]. modified ACEF score = age EF +K K (1→6): creatinine clearance: <60 – k=1 40-50 – k=2 <10 – k=6 Overall in-hospital mortality was evaluated according to low, medium and highSXS and CSS tertiles;

pPCI 7 h after the onset of inferior AMI

Results 134 included patients, in-hospital mortality 9.7% Calculated score values: Low Medium High SYNTAX <11 (8.0) 11-19.5 (15.75) >19.5 (27.5) Patients – N (%) 45 (33.5) 44 (32.8)   CSS <17.4 (9.8) 17.4-39.6 (26.55) >39.6 (65.3) 46 (34.3)

SYNTAX score and in-hospital STEMI mortality alive deceased Patients (N) high low/medium SYNTAX score

Clinical SYNTAX score and in-hospital STEMI mortality alive deceased Patients (N) high low/medium clinical SYNTAX score

Receiver-operator characteristic (ROC) analysis Tested score AUC (95% CI) SE P SYNTAX 0.67 (0.58 - 0.74) 0.0903 0.05 CSS 0.84 (0.76 - 0.89) 0.0719 0.0001 AUC diff. (95% CI) 0.170 (0.027-0.31) 0.073 0.01 sensibility 100-specificity

Conclusion Clinical SYNTAX score (including just 3 simple clinical variables) is more efficient than the angiographic SYNTAX score in predicting the risk of in-hospital mortality after primary PCI for STEMI.

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