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Association of the SYNTAX Score II with cardiac rupture in patients with ST-segment elevation myocardial infarction
Ibrahim Rencuzogullari1, Metin Çağdaş1, Yavuz Karabağ1
1Department of Cardiology, Kafkas University Medical Faculty.
Insights
Cardiac rupture (CR) is a lethal complication after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). The SYNTAX Score II (SSII) independently predicts CR, and higher scores indicate a poorer prognosis, necessitating closer patient follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Medicine
Background:
- Cardiac rupture (CR) remains a significant cause of mortality despite advances in treatment for ST-segment elevation myocardial infarction (STEMI).
- The predictive value of SYNTAX Score II (SSII) for CR following primary percutaneous coronary intervention (pPCI) is not well-established.
- Existing research indicates higher SYNTAX Scores (SS) and SSII are linked to increased mortality in STEMI patients.
Purpose of the Study:
- To investigate the relationship between CR and SS/SSII in STEMI patients undergoing pPCI.
- To determine if SSII is an independent predictor of CR in this patient population.
Main Methods:
- A cohort of 1663 consecutive STEMI patients treated with pPCI was analyzed.
- Patients were divided into groups based on the occurrence of CR.
- Patients were further stratified into three groups according to their SSII values.
Main Results:
- Cardiac rupture (CR) occurred in 1.98% of patients (33 individuals).
- Both SS and SSII were significantly higher in patients who developed CR compared to those who did not (P<0.001 for both).
- SSII was identified as an independent predictor of CR (OR=1.043, P=0.006), with CR incidence increasing across SSII tertiles. Long-term mortality was substantially higher in patients with CR (60.6% vs. 8.8%, P<0.001).
Conclusions:
- The SYNTAX Score II (SSII) is an independent predictor of cardiac rupture (CR) in STEMI patients treated with pPCI.
- Patients who experience CR have a significantly poorer long-term prognosis.
- Enhanced surveillance of STEMI patients with high SSII scores may aid in the early detection and management of CR.
Background:
Despite advances in reperfusion strategies, medical therapy, and emergent surgery, cardiac rupture (CR) is still a major lethal complication. Numerous parameters have been found to be associated with CR development after a primary percutaneous coronary intervention (pPCI). SYNTAX Score (SS) and SYNTAX Score II (SSII) have been studied in ST-segment elevation myocardial infarction (STEMI) patients, and higher scores have been associated with higher mortality. However, the relationship between CR and SSII is unclear. This study investigates the possible relationship between CR and SS, SSII in STEMI patients treated with pPCI.
Patients And Methods:
We enrolled 1663 consecutive STEMI patients treated with pPCI, who were divided into two groups according to CR development and compared with each other. Patients were further stratified into the three groups according to their SSII values.
Results:
In this study, 33 (1.98%) patients developed CR. Both SS and SSII of those with CR were significantly higher than those without (19.27±4.0 vs. 16.40±4.55; P<0.001 and 49.40±16.54 vs. 30.92±11.80; P<0.001, respectively). It was also observed that CR increased gradually according to increasing SSII tertiles. SSII was found to be an independent predictor for CR (odds ratio=1.043, 95% confidence interval: 1.012-1.074; P=0.006). In the long-term follow-up, all-cause mortality was significantly higher in patients with CR than those without (60.6 vs. 8.8%; P<0.001).
Conclusion:
This study shows that SSII is an independent predictor for CR. Furthermore, patients with CR were associated with a poor prognosis. Closer follow-up of patients with high SSII may be useful in the early detection and treatment of this fatal complication.