Value of the SYNTAX Score in ST-Elevation Myocardial Infarction Patients With a Concomitant Chronic Total Coronary Occlusion(from the EXPLORE Trial).

MedStar author(s):
Citation: American Journal of Cardiology. 123(7):1035-1043, 2019 04 01.PMID: 30654929Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Coronary Occlusion/co [Complications] | *Coronary Vessels/dg [Diagnostic Imaging] | *Magnetic Resonance Imaging, Cine/mt [Methods] | *Percutaneous Coronary Intervention/mt [Methods] | *ST Elevation Myocardial Infarction/co [Complications] | Aged | Chronic Disease | Coronary Angiography | Coronary Occlusion/di [Diagnosis] | Coronary Occlusion/su [Surgery] | Female | Follow-Up Studies | Humans | Male | Middle Aged | Retrospective Studies | Severity of Illness Index | ST Elevation Myocardial Infarction/di [Diagnosis] | ST Elevation Myocardial Infarction/su [Surgery]Year: 2019Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: `To analyze the impact of additional coronary artery disease, quantified by the SYNTAX (SYNergy between PCI with TAXus and cardiac surgery) score, on left ventricular ejection fraction (LVEF) and long-term outcomes in a cohort of ST-elevated myocardial infarction (STEMI) patients with a concomitant chronic total coronary occlusion (CTO). A total of 302 STEMI patients were randomized to percutaneous coronary intervention of a CTO (CTO PCI) (n=148) or conservative CTO treatment (n=154). SYNTAX scores were calculated by an independent corelab (Cardialysis BV, Rotterdam) at two time-points: (1) at baseline, and (2) after primary PCI in the conservative CTO arm and after CTO PCI in the invasive arm (named 'discharge SYNTAX score'). The population was divided in two groups (below or equal to the median SYNTAX score preprimary PCI, or above the median). At 4-month follow-up, the LVEF was significantly lower in patients in the group with a SYNTAX score above the group median (42.8% vs 48.5%, p=0.001), and the SYNTAX score was an independent predictor for LVEF at 4 months (beta-0.151 (SE 0.068), p=0.028). In the group with a SYNTAX score above the group median the mortality rate was higher (10.1% vs 3.9%, p=0.025), and there was a trend towards a higher MACE rate (15.4% vs 8.5%, p=0.063). In conclusion, in this sub-analysis of the EXPLORE trial we observed a worse LVEF and a higher mortality rate for patients with a SYNTAX score above the median. We found that the SYNTAX score is an independent negative predictor for LVEF and an independent positive predictor for LVEDV at 4-month follow-up.Copyright (c) 2019. Published by Elsevier Inc.All authors: Claessen BE, Delewi R, Elias J, Eriksen E, EXPLORE investigators, Garcia-Garcia HM, Henriques JPS, Hoebers LP, Ouweneel DM, Ramunddal T, Scheunhage EM, van der Schaaf RJ, van Dongen IMOriginally published: American Journal of Cardiology. 2019 Jan 04Fiscal year: FY2019Digital Object Identifier: Date added to catalog: 2019-01-28
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30654929 Available 30654929

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

`To analyze the impact of additional coronary artery disease, quantified by the SYNTAX (SYNergy between PCI with TAXus and cardiac surgery) score, on left ventricular ejection fraction (LVEF) and long-term outcomes in a cohort of ST-elevated myocardial infarction (STEMI) patients with a concomitant chronic total coronary occlusion (CTO). A total of 302 STEMI patients were randomized to percutaneous coronary intervention of a CTO (CTO PCI) (n=148) or conservative CTO treatment (n=154). SYNTAX scores were calculated by an independent corelab (Cardialysis BV, Rotterdam) at two time-points: (1) at baseline, and (2) after primary PCI in the conservative CTO arm and after CTO PCI in the invasive arm (named 'discharge SYNTAX score'). The population was divided in two groups (below or equal to the median SYNTAX score preprimary PCI, or above the median). At 4-month follow-up, the LVEF was significantly lower in patients in the group with a SYNTAX score above the group median (42.8% vs 48.5%, p=0.001), and the SYNTAX score was an independent predictor for LVEF at 4 months (beta-0.151 (SE 0.068), p=0.028). In the group with a SYNTAX score above the group median the mortality rate was higher (10.1% vs 3.9%, p=0.025), and there was a trend towards a higher MACE rate (15.4% vs 8.5%, p=0.063). In conclusion, in this sub-analysis of the EXPLORE trial we observed a worse LVEF and a higher mortality rate for patients with a SYNTAX score above the median. We found that the SYNTAX score is an independent negative predictor for LVEF and an independent positive predictor for LVEDV at 4-month follow-up.

Copyright (c) 2019. Published by Elsevier Inc.

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