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Prognostic impact of baseline and residual SYNTAX scores in cardiogenic shock
Author(s) -
Javanainen Tuija,
SansRoselló Jordi,
Harjola VeliPekka,
Nieminen Markku S.,
Lassus Johan,
Sionis Alessandro,
Varpula Marjut,
Jurkko Raija
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27716
Subject(s) - medicine , timi , conventional pci , cardiology , myocardial infarction , percutaneous coronary intervention , cardiogenic shock , coronary artery disease , acute coronary syndrome , interquartile range , framingham risk score , population , disease , environmental health
Objectives The aim was to assess the extent of coronary artery disease and revascularization using baseline SYNTAX Score (bSS) and residual SYNTAX Score (rSS) in patients with cardiogenic shock (CS) secondary to ST‐segment elevation myocardial infarction (STEMI). The prognostic impact of SYNTAX Score (SS) was evaluated and assessed for additive value over clinical risk scores. Background bSS and rSS have been proven to be useful in risk stratification in stable coronary artery disease as well as in acute coronary syndromes, but they have not been studied in STEMI related CS. Methods Patients from a multinational prospective study of CS were analyzed. The study population was divided into tertiles according to bSS. The Cox regression and receiver operating characteristic (ROC) curves were used to assess the predictive power of SS. Results Of the 61 studied patients, 85% were male and the mean age was 67 years. Median bSS was 22 (15–32) and rSS 7 (0–13). Ninety‐day mortality was 43%. bSS had negative prognostic value in multivariable analysis (HR 1.06, 95% CI 1.01–1.10). However, additive value over clinical risk scores was limited. rSS was not associated with mortality, whereas post‐percutaneous coronary intervention (PCI) TIMI flow 3 of infarct‐related artery (IRA) predicted better survival. Conclusions In STEMI related CS, the added value of bSS and rSS over clinical assessment and risk scores is limited. Our results suggest that while immediate PCI in order to restore blood flow to the IRA is essential, deferring the treatment of residual lesions does not seem to be associated with worse prognosis.