title: SYNTAX score:  an independent predictor of long-term cardiac mortality in patients with acute ST-elevation myocardial infarction.
abstract: BACKGROUND
  This observational study aimed to determine whether the SYNergy between percutaneous coronary intervention (PCI) with TAXUS drug-eluting stent and the cardiac surgery (SYNTAX) score can act as an independent predictor for cardiac death on long-term follow-up in patients with acute ST-elevation myocardial infarction (STEMI).
  
  
  METHODS
  One hundred and fifty-three patients admitted to the Chang Gung Memorial Hospital in Linkou because of acute STEMI from 1 January 2008 to 31 December 2009, who subsequently underwent a primary PCI, were included in this study. SYNTAX scores were calculated immediately after the primary PCI; and the prognostic value of the SYNTAX score in relation to cardiovascular events, which were defined as low-risk (SYNTAX score 0-22) and intermediate-risk to high-risk (SYNTAX score>22), was determined. Long-term follow-up was available in 141 patients (92%, mean follow-up duration of 30±11 months).
  
  
  RESULTS
  By Kaplan-Meier estimates, cardiac death-free survival was 99.1% in the low-risk group vs. 78.6% in the intermediate-risk to high-risk group at 42 months of follow-up (P<0.001). For all-cause death, the survival rate was 93.1% in the low-risk group vs. 78.6% in the intermediate-risk to high-risk group at 42 months of follow-up (P=0.002). Multivariate Cox-regression analysis showed that independent predictors of cardiac death were the SYNTAX score (odds ratio 15.90; 95% confidence interval 1.04-244.21) and symptom to onset-to-therapy interval (odds ratio 25.57; 95% confidence interval 1.00-655.96).
  
  
  CONCLUSIONS
  The SYNTAX score is a strong independent predictor of cardiac death in intermediate-risk to high-risk patients with acute STEMI.
authors.affiliation: Second Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Yang
authors.forename: Ming-Jer
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Chen
authors.forename: Shang-Hung
authors.initials: SH
authors.lastname: Chang
authors.forename: Chao-Yung
authors.initials: CY
authors.lastname: Wang
authors.forename: Cheng-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: I-Chang
authors.initials: IC
authors.lastname: Hsieh
mesh_terms: D000368:Aged; D000465:Algorithms; D002423:Cause of Death; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome