Using the SYNTAX score to predict myocardial injury early after on-pump coronary artery bypass surgery: a
Razan Al Namat1,2, Alexandru Burlacu2,3, Grigore Tinica2,4
1Cardiovascular Rehabilitation Clinic, Iasi, Romania.
Insights
The SYNTAX score (SS) strongly predicts early myocardial injury after coronary artery bypass grafting (CABG). Higher SS indicates a greater risk of cardiac biomarker elevation post-surgery, aiding in risk stratification.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Biomarkers
Background:
- Post-coronary artery bypass grafting (CABG) myocardial injury, indicated by elevated cardiac biomarkers (CK-MB, cardiac troponin I, hFABP), has significant prognostic implications.
- The relationship between coronary atherosclerotic burden complexity and early post-CABG myocardial injury remains under-explored.
- Defining myocardial injury as biomarker elevation below the threshold for myocardial infarction (MI) is clinically significant due to associated negative prognostic rates.
Purpose of the Study:
- To investigate the correlation and predictive capability of the SYNTAX score (SS) for early myocardial injury following on-pump CABG.
- To assess the association between coronary atherosclerotic complexity, quantified by SS, and procedural myocardial injury.
Main Methods:
- Analysis of 120 consecutive patients undergoing CABG.
- Collection of demographic, medical history, cardiovascular risk factor, and echocardiography data.
- Measurement of cardiac biomarkers (CK-MB, cTnI, hFABP) at 6 hours post-CABG.
- Multivariate linear regression analysis to identify independent predictors of cardiac biomarker elevation.
Main Results:
- The SYNTAX score (SS) was the most significant predictor of myocardial injury, showing a strong correlation with elevated cardiac biomarkers (p < 0.001).
- Hypertension and creatinine clearance were associated with cardiac troponin I (cTnI) and heart-type fatty acid binding protein (hFABP) levels.
- Diabetes was correlated with hFABP levels.
- In multivariate analysis, SS independently predicted myocardial injury, strongly associated with hFABP (p < 0.001) and cTnI (p < 0.001), but not CK-MB.
Conclusions:
- The SYNTAX score (SS) is a robust predictor of early myocardial injury after on-pump CABG, as evidenced by elevated cardiac biomarkers.
- The strong correlation between SS and myocardial injury suggests its utility in predicting post-operative biomarker rise.
- This finding underscores the clinical significance of defining and identifying myocardial injury in the context of CABG.
Introduction:
Marked isolated elevation of cardiac biomarkers (CK-MB, cardiac troponin I, heart-type fatty acid binding protein, hFABP) within 48 hours after coronary artery bypass surgery (CABG), even in the absence of electrocardiographic/angiographic evidence of myocardial infarction (MI), indicates prognostically significant cardiac procedural myocardial injury. There are no data exploring the relationship between the complexity of coronary atherosclerotic burden and early post-CABG myocardial injury.
Aim:
To analyse correlations and predictive strength of the SYNTAX score (SS) for early myocardial injury after on-pump CABG.
Material And Methods:
One hundred and twenty consecutive patients undergoing CABG were included in the analysis. We obtained data on demographics, medical history, cardiovascular risk factors and echocardiography. Cardiac biomarkers were assessed at 6 hours after CABG. Multivariate linear regression analysis was performed to evaluate independent variables correlated with cardiac biomarkers.
Results:
The most significant predictor for myocardial injury was SS, strongly correlated with the rise of all cardiac biomarkers (p < 0.001). Hypertension and creatinine clearance were associated with cTnI and hFABP. Diabetes was corelated with hFABP. In a multivariate analysis including all significant predictors, SS remained an independent predictor for myocardial injury, strongly associated with hFABP (p < 0.001, OR = 5.79, 95% CI: 3.59-7.98), cTnI (p < 0.001, OR = 6.49, 95% CI: 4.78-8.20), but not with CK-MB (95% CI: 0.61-1.07).
Conclusions:
Defining myocardial injury as elevation of cardiac biomarkers between normal values and the cut-off for MI has a tremendous clinical significance as patients maintain high negative prognostic rates. SS could be used to predict post-operative rise of cardiac biomarkers, the correlation between SS and myocardial injury being very solid.
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