The Association Between SYNTAX Score and Left Ventricular Myocardial Function in Patients with Acute ST-Elevation Myocardial Infarction

Zhaohui Liu¹ and Tingting Su^2,

¹Department of Respiration, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China

²Department of Cardiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China

Cite this paper:
Zhaohui Liu and Tingting Su. The Association Between SYNTAX Score and Left Ventricular Myocardial Function in Patients with Acute ST-Elevation Myocardial Infarction. American Journal of Cardiovascular Disease Research. 2024; 9(1):1-6. doi: 10.12691/ajcdr-9-1-1

Abstract

Background: Left ventricular dysfunction were mainly caused by acute ST-elevation myocardial infarction (STEMI), often indicates a poor prognosis of cardiac arrest or sudden cardiac death. There were up to 50% patients with acute STEMI developed to left ventricular dysfunction even with the timing of coronary revascularization and mortality continues to rise in this population. The SYNTAX score is a new system that calculates risk on the basis of the complexity of coronary artery anatomy and is used to select the optimal technique for revascularization in patients with significant coronary artery disease. This observational study aimed to investigate the associations of SYNTAX score and left ventricular dysfunction caused by acute STEMI. Methods: 198 patients admitted to the Cardiovascular Center of the Seventh Affiliated Hospital of Sun Yat-Sen University because of acute STEMI from 1 January 2022 to 31 December 2022, who subsequently underwent emergency or elective coronary angiography (CAG) or percutaneous coronary intervention (PCI), were included in this study. According to left ventricular dysfunction patients were divided into two groups as the group1 of left ventricular dysfunction and the group2 of normal left ventricular function. SYNTAX score was calculated immediately after the CAG to assess the complexity and severity of coronary artery disease. Results: We included 198 hospitalizations for acute STEMI with a mean age of 57.0 ± 13.3 years, 14.3% patients were female. There were 43 patients in group1 and 153 patients in group2. The baseline characteristics of the study population are shown in . There was significant difference between the two groups with SYNTAX score, white blood cell (WBC) count, neutrophil count, urea, estimated glomerular filtration rate (eGFR), high density lipoprotein cholesterol (HDL-C), N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), creatine kinase-MB (CK-MB), and in-hospital mortality. Univariate and Multivariable regression models suggested that SYNTAX score was an independent risk factor for left ventricular dysfunction. The fitted curve indicates a linear relationship between SYNTAX score and left ventricular dysfunction. Conclusion: SYNTAX score was an independent risk factor for left ventricular dysfunction in patients with acute STEMI, and the relationship between them are negative.

Keywords:
coronary artery disease Acute ST-elevation myocardial infarction SYNTAX score left ventricular dysfunction in-hospital mortality

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Goel K, Pinto D S, Gibson C M. Association of time to reperfusion with left ventricular function and heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention: a systematic review [J]. Am Heart J, 2013, 165(4): 451-467.
[2]	van Dongen I M, Elias J, Garcia-Garcia H M, et al. Value of the SYNTAX Score in ST-Elevation Myocardial Infarction Patients With a Concomitant Chronic Total Coronary Occlusion(from the EXPLORE Trial) [J]. Am J Cardiol, 2019, 123(7): 1035-1043.
[3]	Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation [J]. Rev Esp Cardiol (Engl Ed), 2017, 70(12): 1082.
[4]	Gottdiener J S, Bednarz J, Devereux R, et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials [J]. J Am Soc Echocardiogr, 2004, 17(10): 1086-1119.
[5]	Kundi H, Balun A, Cicekcioglu H, et al. Admission Endocan Level may be a Useful Predictor for In-Hospital Mortality and Coronary Severity Index in Patients With ST-Segment Elevation Myocardial Infarction [J]. Angiology, 2017, 68(1): 46-51.
[6]	Kundi H, Kiziltunc E, Cetin M, et al. Association of monocyte/HDL-C ratio with SYNTAX scores in patients with stable coronary artery disease [J]. Herz, 2016, 41(6): 523-529.
[7]	Karadeniz M, Duran M, Akyel A, et al. High Sensitive CRP Level Is Associated With Intermediate and High Syntax Score in Patients With Acute Coronary Syndrome [J]. Int Heart J, 2015, 56(4): 377-380.
[8]	Silvestre-Roig C, Braster Q, Ortega-Gomez A, et al. Neutrophils as regulators of cardiovascular inflammation [J]. Nature reviews cardiology, 2020, 17(6): 327-340.
[9]	Reindl M, Tiller C, Holzknecht M, et al. Association of Myocardial Injury With Serum Procalcitonin Levels in Patients With ST-Elevation Myocardial Infarction [J]. JAMA Netw Open, 2020, 3(6): e207030.
[10]	Kim S, Eliot M, Koestler D C, et al. Association of Neutrophil-to-Lymphocyte Ratio With Mortality and Cardiovascular Disease in the Jackson Heart Study and Modification by the Duffy Antigen Variant [J]. JAMA Cardiol, 2018, 3(6): 455-462.
[11]	Schernthaner C, Paar V, Wernly B, et al. Elevated plasma levels of interleukin-16 in patients with acute myocardial infarction [J]. Medicine (Baltimore), 2017, 96(44): e8396.
[12]	Helseth R, Knudsen E C, Eritsland J, et al. Glucose associated NETosis in patients with ST-elevation myocardial infarction: an observational study [J]. BMC Cardiovasc Disord, 2019, 19(1): 221.
[13]	Tiller C, Reindl M, Holzknecht M, et al. High sensitivity C-reactive protein is associated with worse infarct healing after revascularized ST-elevation myocardial infarction [J]. Int J Cardiol, 2021, 328: 191-196.
[14]	Yang C H, Hsieh M J, Chen C C, et al. SYNTAX score: an independent predictor of long-term cardiac mortality in patients with acute ST-elevation myocardial infarction [J]. Coron Artery Dis, 2012, 23(7): 445-449.
[15]	Chew D S, Wilton S B, Kavanagh K, et al. Left ventricular ejection fraction reassessment post-myocardial infarction: Current clinical practice and determinants of adverse remodeling [J]. Am Heart J, 2018, 198: 91-96.
[16]	Bayam E, Kalcik M, Ozturkeri B, et al. The relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction [J]. Acta Cardiol, 2021, 76(8): 870-877.
[17]	Corral A J, Schuster A, Zacur E, et al. Understanding and Improving Risk Assessment After Myocardial Infarction Using Automated Left Ventricular Shape Analysis [J]. JACC Cardiovasc Imaging, 2022, 15(9): 1563-1574.
[18]	Li J, Li X, Wang Q, et al. ST-segment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data [J]. The Lancet, 2015, 385(9966): 441-451.