title: High SYNTAX score predicts worse in-hospital clinical outcomes in patients undergoing primary angioplasty for acute myocardial infarction.
abstract: OBJECTIVE
  A high SYNTAX score (SXscore) is a predictor of adverse outcomes for stable and unstable coronary syndromes. We aimed to examine whether a high SXscore will determine in-hospital clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.
  
  
  METHODS
  A total of 646 (mean age 56.1 ± 12.5; 516 males, 130 females) patients with STEMI undergoing a primary percutaneous coronary intervention were evaluated prospectively. The study population was divided into tertiles based on the SXscore values. A high SXscore (n=196) was defined as a value in the third tertile (>21.75), and a low SXscore (n=450) was defined as a value in the lower two tertiles (≤21.75). Patients were followed up for in-hospital clinical outcomes.
  
  
  RESULTS
  In-hospital cardiovascular mortality occurred more in the high SXscore group than in the low SXscore group (10.7 and 2.4%, respectively, P<0.001). In a receiver-operating characteristic curve analysis, an SXscore value of 21.75 was identified as an effective cut point in STEMI for in-hospital cardiovascular mortality (area under curve=0.75, 95% confidence interval: 0.66-0.83, P<0.001). An SXscore value of more than 21.75 yielded a sensitivity of 66% and a specificity of 71.5%. A significant association was noted between a high SXscore level and the adjusted risk of in-hospital cardiovascular mortality (odds ratio: 3.92, 95% confidence interval: 1.1-13.9, P=0.03).
  
  
  CONCLUSIONS
  Our findings showed that patients with a high SXscore undergoing primary angioplasty for STEMI have a poor in-hospital survival, and that a high SXscore represents an independent risk factor for in-hospital cardiovascular mortality.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey. doktorseref@hotmail.com
authors.forename: Seref
authors.initials: S
authors.lastname: Kul
authors.forename: Ozgur
authors.initials: O
authors.lastname: Akgul
authors.forename: Huseyin
authors.initials: H
authors.lastname: Uyarel
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ergelen
authors.forename: Okkes T
authors.initials: OT
authors.lastname: Kucukdagli
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Tasal
authors.forename: Ercan
authors.initials: E
authors.lastname: Erdogan
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bacaksiz
authors.forename: Osman
authors.initials: O
authors.lastname: Sonmez
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gul
authors.forename: Nevzat
authors.initials: N
authors.lastname: Uslu
authors.forename: Omer
authors.initials: O
authors.lastname: Goktekin
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D056988:Anterior Wall Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology