The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention.
BACKGROUND
Peri-procedural myocardial injury (PPI) during percutaneous coronary intervention (PCI) is common and associated with a poor outcome. No reliable angiographic or clinical predictors of PPI exist. We evaluated the ability of the SYNTAX score (SXscore), Gensini score, American Heart Association/American College of Cardiology (AHA/ACC) and Society for Cardiovascular Angiography and Intervention (SCAI) classifications to predict PPI.


METHODS
Consecutive patients were included from two existing databases of PCI. Patients with coronary bypass grafts or instent restenosis were excluded. PPI was defined as troponin I elevation (>1.0 microg/L) at 6-24 h post-PCI. Delayed enhancement magnetic resonance imaging distinguished PPI territory in patients undergoing multi-vessel PCI. Quantitative coronary angiography was performed blinded to PPI. In total, 100 patients underwent PCI to 122 vessels. PPI occurred in 20/100 (20.0%) patients.


RESULTS
Mean patient SXscore was higher in patients with PPI (20.6 vs. 12.4, p = 0.0001), however Gensini score was not significantly different (34.2 vs. 27.3, p = 0.15). Mean vessel SXscore was higher in vessels associated with PPI (12.1 vs. 7.6, p = 0.002), but not different for vessel Gensini score (16.2 vs. 13.6, p = 0.42). No vessels with AHA type A or B1 lesions were associated with PPI. Higher AHA scores (B2 and C) were associated with PPI (chi2 for trend 11.6, p = 0.0007). SCAI scores were not predictive of PPI (chi2 for trend 3.6, p = 0.06). By ROC analysis, a patient SXscore of > or = 17 predicted PPI with a sensitivity of 75.0% and specificity of 70.0%.


CONCLUSIONS
Higher SXscores are predictive of myocardial injury, whilst AHA type A and B1 lesions have a high negative predictive value for PPI.
van Gaal
William J
WJ
Department of Cardiology, The Northern Hospital, Epping, Victoria, Australia. William.vangaal@nh.org.au
Ponnuthurai
Francis A
FA
Selvanayagam
Joseph
J
Testa
Luca
L
Porto
Italo
I
Neubauer
Stefan
S
Banning
Adrian P
AP
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents