Residual Synergy between percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score to Predict in-hospital Clinical Outcomes among ST Elevation Myocardial Infarction Patients undergoing Primary Percutaneous Coronary Intervention

Abstract

Background: The SYNergy between Percutaneous Coronary Intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) score (SS) assesses the anatomical complexity of Coronary Artery Disease (CAD). Residual SS (rSS) quantifies the burden of residual CAD following PCI.

Methodology: It was a descriptive cross-sectional study conducted at the Peshawar Institute of Cardiology inpatient departments, from March 2023 to Aug 2023. Patients, who satisfied the criteria for type 1 Myocardial Infarction (MI), were included in the study by non-probability consecutive sampling technique. Baseline SS (bSS) and rSS were calculated using an online calculator (syntax.org/calculator) Patients were stratified as Complete Revascularization (CR) rSS =0, Reasonably Incomplete Revascularization (RICR) rSS >0 and ≤8, and Incomplete Revascularization (ICR) rSS >8. In-hospital clinical outcomes included all causes in-hospital mortality and Major Adverse Cardiac and Cerebrovascular Events (MACCE) were recorded. The analyses were conducted using the statistics and data analysis (STATA) version 14.2.

Results: A total of 426 patients were included in our study. The most common risk factor for CAD was hypertension. In the ICR group, 21.4% of patients had Significant Left Main Stem disease. The majority of the CR subjects had significant single-vessel CAD. In CR and RICR groups, the Left Anterior Descending artery while in ICR Right Coronary Artery was the common culprit vessel causing MI. All-cause in-hospital mortality was 4.2% and MACCE was 11.03%, and were common among the ICR subjects (9.8% and 10.7%, respectively), but had a comparable proportion in CR and RICR groups. Logistic regression revealed a significant association between rSS categories and mortality, (Odds ratio 2.42; 95% CI: 1.28 to 4.57).

Conclusion: The rSS is a useful tool in quantifying incomplete revascularization among STEMI patients undergoing primary PCI, and ICR appears to confer a higher in-hospital mortality and MACCE.