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Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

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Abstract

This study evaluated additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). All six scores were calculated in 209 consecutive STEMI patients undergoing pPCI. Primary end-point was the major adverse cardiovascular event (MACE—composite of cardiovascular mortality, non-fatal myocardial infarction and stroke); secondary end point was cardiovascular mortality. Patients were stratified according to the SYNTAX score tertiles (≤12; between 12 and 19.5; >19.5). The median follow-up was 20 months. Rates of MACE and cardiovascular mortality were highest in the upper tertile of the SYNTAX score (p < 0.001 and p = 0.003, respectively). SYNTAX score was independent multivariable predictor of MACE and cardiovascular mortality when added to GRACE, TIMI, ZWOLLE, and PAMI risk scores. However, the SYNTAX score did not improve the Cox regression models of MACE and cardiovascular mortality when added to the CADILLAC score. The SYNTAX score has predictive value for MACE and cardiovascular mortality in patients with STEMI undergoing primary PCI. Furthermore, SYNTAX score improves prognostic performance of well-established GRACE, TIMI, ZWOLLE and PAMI clinical scores, but not the CADILLAC risk score. Therefore, long-term survival in patients after STEMI depends less on detailed angiographical characterization of coronary lesions, but more on clinical characteristics, myocardial function and basic angiographic findings as provided by the CADILLAC score.

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Abbreviations

CADILLAC:

Controlled abciximab and device investigation to lower late angioplasty complications

GRACE:

Global registry of acute coronary events

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiovascular event

PAMI:

Primary angioplasty in myocardial infarction

pPCI:

Primary percutaneous coronary intervention

STEMI:

ST-segment elevation myocardial infarction

SYNTAX:

Synergy between percutaneous coronary intervention with taxus and cardiac surgery

TIMI:

Thrombolysis in myocardial infarction

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Acknowledgments

This study was partially supported by the grant (number 41022) of the Ministry of Education and Science of the Republic of Serbia.

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Authors and Affiliations

  1. Clinic for Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000, Belgrade, Serbia

    Voin Brkovic, Milan Dobric, Branko Beleslin, Vojislav Giga, Vladan Vukcevic, Sinisa Stojkovic, Goran Stankovic, Milan A. Nedeljkovic, Dejan Orlic, Miloje Tomasevic, Jelena Stepanovic & Miodrag Ostojic

  2. School of Medicine, University of Belgrade, 8 Doktora Subotica, 11000, Belgrade, Serbia

    Branko Beleslin, Vladan Vukcevic, Sinisa Stojkovic, Goran Stankovic, Milan A. Nedeljkovic, Dejan Orlic, Jelena Stepanovic & Miodrag Ostojic

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  1. Voin Brkovic
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Correspondence to Branko Beleslin.

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Brkovic, V., Dobric, M., Beleslin, B. et al. Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiovasc Imaging 29, 1215–1228 (2013). https://doi.org/10.1007/s10554-013-0202-1

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