Why the study?
Coronary artery disease complexity and revascularization extent have not been thoroughly investigated as prognostic factors in STEMI patients undergoing primary PCI for unprotected left main culprit lesions.
Do baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index predict mortality in STEMI patients undergoing primary PCI for UPLMCA lesions?
Cohort (n=81)
Do baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index predict mortality in STEMI patients undergoing primary PCI for UPLMCA lesions?
Answers are grounded in this paper and cite their sources.
In STEMI patients undergoing primary PCI for unprotected left main lesions, the complexity of coronary disease and extent of revascularization (measured by SYNTAX scores) are independent predictors of long-term mortality.
OBJECTIVES: The study evaluated the correlation between baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) on an unprotected left main coronary artery lesion (UPLMCA). BACKGROUND: Previous studies on primary PCI in UPLMCA have identified cardiogenic shock, TIMI 0/1 flow, and cardiac arrest, as prognostic factors of an unfavourable outcome, but the complexity of coronary artery disease and the extent of revascularization have not been thoroughly investigated in these high-risk patients. METHODS: 30-day, 1-year, and long-term outcomes were analyzed in a cohort of retrospectively selected, 81 consecutive patients with STEMI, and primary PCI on UPLMCA. RESULTS: Cardiogenic shock (p=0.001), age (p=0.008), baseline SYNTAX Score II (p=0.006), and SYNTAX Revascularization Index (p=0.046) were independent mortality predictors at one-year follow-up. Besides cardiogenic shock (HR 3.28, p<0.001), TIMI 0/1 flow (HR 2.17, p=0.021) and age (HR 1.03, p=0.006), baseline SYNTAX Score II (HR 1.06, p=0.006), residual SYNTAX Score (HR 1.03, p=0.041), and SYNTAX Revascularization Index (HR 0.9, p=0.011) were independent predictors of mortality at three years of follow-up. In patients with TIMI 0/1 flow, the presence of Rentrop collaterals was an independent predictor for long-term survival (HR 0.24; p=0.049). CONCLUSIONS: In this study, the complexity of coronary artery disease and the extent of revascularization represent independent mortality predictors at long-term follow-up.
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Homorodean et al. (2019) conducted a cohort in ST-elevation myocardial infarction (STEMI) with unprotected left main coronary artery lesion (UPLMCA) (n=81). Coronary artery disease complexity and revascularization extent (SYNTAX scores) was evaluated on Mortality at three years of follow-up (HR 1.06, p=0.006).
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