title: The SYNTAX score predicts early mortality risk in the elderly with acute coronary syndrome having primary PCI.
abstract: BACKGROUND
  The SYNTAX score (SXscore), an angiographic score reflecting coronary lesion complexity, predicts clinical outcomes in patients with left main or multivessel disease, and in patients with ST-segment elevation myocardial infarction undergoing primary PCI. The clinical SXscore (CSS) integrates the SXscore and clinical variables (age, ejection fraction, serum creatinine) into a single score. We analyzed these scores in elderly patients with acute coronary syndrome (ACS) undergoing primary PCI. The purpose of this analysis was not to decide which patients should undergo PCI, but to predict clinical outcomes in this population.
  
  
  METHODS
  The SXscore was determined in a consecutive series of 114 elderly patients (mean age, 79.6 ± 4.1 years) undergoing primary PCI for ACS. Outcomes were stratified according to SXscore tertiles: SXLOW ≤15 (n = 39), 15< SXMID <23 (n = 40), and SXHIGH ≥23 (n = 35). The primary endpoint was all-cause mortality at 30 days. Secondary endpoints were nonfatal major adverse cardiac and cerebrovascular events (MACCE) at 30 days, and 1-year outcomes in patients discharged alive.
  
  
  RESULTS
  Mortality at 30 days was higher in the SXHIGH group compared with the aggregate SXLOW+MID group (37.1% vs 5.1%; P<.0001), and in the CSSHIGH group compared with the aggregate CSSLOW+MID group (25.5% vs 1.4%; P=.0001). MACCE rates at 30 days were similar among SXscore tertiles. The CSS predicted 1-year MACCE rates (12.1% for CSSHIGH vs 3.1% for CSSLOW+MID; P=.03).
  
  
  CONCLUSIONS
  The SXscore predicts 30-day mortality in elderly patients with ACS undergoing primary PCI. In patients discharged alive, the CSS predicts risk of MACCE at 1 year.
authors.affiliation: Department of Cardiology, CardioCentro Ticino, Via Tesserete, Lugano, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Scherff
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vassalli
authors.forename: Daniel
authors.initials: D
authors.lastname: Sürder
authors.forename: Antonio
authors.initials: A
authors.lastname: Mantovani
authors.forename: Carlo
authors.initials: C
authors.lastname: Corbacelli
authors.forename: Elena
authors.initials: E
authors.lastname: Pasotti
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Pedrazzini
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors