title: Can Syntax Score predict angiographically visible distal embolization during primary percutaneous coronary intervention?
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PPCI) is the most effective and validated treatment strategy of ST segment elevation myocardial infarction (STEMI). Nevertheless, normal myocardial perfusion cannot always be achieved at the end of the procedure in a significant number of patients with STEMI. The aim of this study was to investigate angiographic and procedural predictors of angiographically visible distal embolization (AVDE) during PPCI and the assessment of mid and long term mortality.
  
  
  METHODS
  Four hundred and sixty five consecutive patients undergoing PPCI for acute STEMI and matching eligibility criteria of the study between January 2010 and December 2011 were enrolled in the study. Patients were divided into two groups; 61 (13.1%) with AVDE and 404 patients without AVDE based on angiograms performed during PPCI.
  
  
  RESULTS
  Longer stent length, higher balloon diameter, low Syntax score (SxS), low LVEF, high neutrophil/lymphocyte ratio and chronic renal failure were seemed to be associated with AVDE in univariate analysis and these variables were entered into multivariate analysis. In multivariate analyzes, stent length, LVEF and low SxS were found to be associated with AVDE (OR: 1,11, 95 % CI: 1,06-1,16, p< 0,001; OR: 0,80, 95%CI: 0.80-0.91, p< 0,001; OR: 0,85, 95%CI: 0,79-0,91, P< 0,001, respectively).
  
  
  CONCLUSIONS
  This study concluded that low SxS, longer stent length, low LVEF were predicting risk factors associated with the development of AVDE in patients undergoing PPCI. Low SxS associated with AVDE may be linked to the strong relation between AVDE and high thrombus burden and composition of atherosclerotic plaque rather than complex coronary lesions.
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey - ismailbiyikmd@yahoo.com.
authors.forename: Ismail
authors.initials: I
authors.lastname: Biyik
authors.forename: Ibrahim F
authors.initials: IF
authors.lastname: Akturk
authors.forename: Derya
authors.initials: D
authors.lastname: Ozturk
authors.forename: Cetin
authors.initials: C
authors.lastname: Sarikamis
authors.forename: Omer
authors.initials: O
authors.lastname: Celik
authors.forename: Fatih
authors.initials: F
authors.lastname: Uzun
authors.forename: Ahmet
authors.initials: A
authors.lastname: Arif Yalcin
authors.forename: Gunduz
authors.initials: G
authors.lastname: Yildiz
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ayaz
authors.forename: Mustafa K
authors.initials: MK
authors.lastname: Erol
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003326:Coronary Circulation; D004452:Echocardiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010477:Perfusion; D011237:Predictive Value of Tests; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome