title: The value of the Clinical SYNTAX Score in predicting long-term prognosis in patients with ST-segment elevation myocardial infarction who have undergone primary percutaneous coronary intervention.
abstract: BACKGROUND
  The Clinical SYNTAX Score (CSS) combines anatomical and clinical risk assessment.
  
  
  OBJECTIVE
  This study was designed to evaluate CSS as a predictor of prognosis in patients with ST-elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (p-PCI).
  
  
  METHODS
  We evaluated 433 patients who were diagnosed with STEMI and underwent p-PCI. CSS was calculated by multiplying the anatomically derived SYNTAX score (Sx) by the modified age, creatinine, and ejection fraction score. Patients were divided into tertiles according to the CSS: CSS(Low)≤14 (n=141), 14<CSS(Mid)≤26 (n=144), and CSS(High)>26 (n=148). The primary endpoints were defined as all-cause mortality, myocardial infarction, and cerebrovascular events over 15 months' follow-up.
  
  
  RESULTS
  Primary endpoints were achieved in 9.2% of patients with CSS≤14, 12.5% of those with 14<CSS≤26, and 28.4% of those with CSS>26 (P<0.001). Kaplan-Meier analysis showed that the CSS>26 group had a significantly higher incidence of primary endpoints [P (log-rank)<0.001]. CSS>26 was identified as an independent predictor for all-cause mortality, myocardial infarction, and cerebrovascular events (hazard ratio 3.58, 95% confidence interval 1.68-7.60, P=0.001). Receiver operating characteristic analysis found areas under the curve of 0.66, 0.59, and 0.64 for CSS, Sx score, and age, creatinine, and ejection fraction score (P<0.001, P=0.01, P<0.001, respectively).
  
  
  CONCLUSIONS
  CSS may be better than the Sx score for predicting long-term prognosis in patients with STEMI undergoing p-PCI.
authors.affiliation: Department of Cardiology, Institute of Cardiology, Istanbul University, Istanbul, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Cetinkal
authors.forename: Sait M
authors.initials: SM
authors.lastname: Dogan
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kocas
authors.forename: Okay
authors.initials: O
authors.lastname: Abaci
authors.forename: Sukru
authors.initials: S
authors.lastname: Arslan
authors.forename: Betul
authors.initials: B
authors.lastname: Balaban Kocas
authors.forename: Osman S
authors.initials: OS
authors.lastname: Karaca
authors.forename: Ahmet
authors.initials: A
authors.lastname: Buyuk
authors.forename: Nur
authors.initials: N
authors.lastname: Firidin
authors.forename: Ahmet
authors.initials: A
authors.lastname: Yildiz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology