Prognostic Utility of Culprit SYNTAX Score in Patients With Cardiogenic Shock Complicating ST-Segment Elevation...

Area of Science:

• Cardiology
• Interventional Cardiology
• Critical Care Medicine

Background:

• Higher SYNTAX score (SS) indicates poor prognosis in cardiogenic shock complicating ST-elevation myocardial infarction (CS-STEMI).
• The predictive value of culprit-lesion SYNTAX score (cul-SS) versus SS in CS-STEMI remains unclear, despite evidence supporting culprit-lesion-only primary percutaneous coronary intervention (PCI).

Purpose of the Study:

• To compare the predictive utility of cul-SS and SS for in-hospital mortality in CS-STEMI patients.
• To identify factors that can augment the predictive accuracy of cul-SS.

Main Methods:

• Retrospective analysis of 215 CS-STEMI patients from 2010-2019.
• Comparison of SS and cul-SS in predicting in-hospital mortality.
• Multivariate analysis and assessment of Area Under the Curve (AUC) for predictive models.

Main Results:

• In-hospital mortality occurred in 37% of patients.
• SS ≥22, cul-SS ≥11, final TIMI flow ≤2, and no-reflow phenomenon were associated with mortality.
• cul-SS ≥11 was an independent predictor (OR 2.6, p=0.010) and showed better predictive value than SS, especially in multi-vessel disease.
• AUC for cul-SS ≥11 (0.617) improved to 0.745 when combined with TIMI flow ≤2, no-reflow, and low CO2 content.

Conclusions:

• The cul-SS may be a more potent predictor of in-hospital mortality in CS-STEMI patients compared to the overall SS.
• Combining cul-SS with other clinical and angiographic factors significantly enhances its predictive capability for mortality.