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

2. 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;

3. 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 ;

4. 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 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

5. 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

6. 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;

7. pPCI 7 h after the onset of inferior AMI

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

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

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

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

12. 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.

13. THANK YOU