Key result
Non-IRA SYNTAX score ≥2.5 is linked to ~115% higher MACE risk after primary PCI.
Why the study?
The impact of the severity of stenosis in a non-infarct-related artery on long-term prognosis after primary PCI in STEMI patients was unclear.
Does a non-infarct-related artery SYNTAX score ≥ 2.5 predict worse long-term outcomes in STEMI patients undergoing primary PCI?
Cohort (n=301)
No
Does a non-infarct-related artery SYNTAX score ≥ 2.5 predict worse long-term outcomes in STEMI patients undergoing primary PCI?
Hazard Ratio: 2.15 (95% CI 1.21–3.79)
Absolute Event Rate: 25.3% vs 13.3%
p-value: p=0.008
In STEMI patients undergoing primary PCI, moderate to severe non-infarct-related artery stenosis (SYNTAX score ≥ 2.5) is an independent predictor of long-term major adverse cardiac events and all-cause mortality.
OBJECTIVE: We investigated the impact of the severity of stenosis in a non-infarct-related artery (IRA) on the long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: Three hundred one consecutive patients (age: 59.7 ± 13.2 years, 85.5% men) underwent primary PCI during 2009-2012. Receiver operating characteristic curve analysis found the optimal cutoff for non-IRA SYNTAX score (SS) to be 2.5. We divided the patients into two groups according to this cutoff value. RESULTS: By multivariable analysis, non-IRA SS (≥ 2.5) was an independent predictor of major adverse cardiac events (hazard ratio [HR]: 2.15, 95% confidence interval [CI]: 1.21-3.79, P = 0.008) and all-cause mortality (HR: 3.49, 95% CI: 1.13-10.8, P = 0.03). However, the prediction of cardiovascular mortality had only borderline significance (HR: 3.29, 95% CI: 0.90-12.08, P = 0.07). CONCLUSION: STEMI patients treated with primary PCI and moderate to severe non-IRA stenosis (SS ≥ 2.5) have more subsequent cardiac events. Those populations should be treated with more aggressive preventive and medical management.
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Su et al. (2014) conducted a cohort in Acute ST Segment Elevation Myocardial Infarction (STEMI) (n=301). Moderate to severe non-infarct-related artery (IRA) stenosis (SYNTAX score ≥2.5) vs. No or mild non-IRA stenosis (SYNTAX score <2.5) was evaluated on Major adverse cardiac events (MACE), defined as a composite of cardiovascular death, reinfarction, target vessel revascularization for ischemia, or stroke (HR 2.15, 95% CI 1.21-3.79, p=0.008). In patients with STEMI undergoing primary PCI, moderate to severe non-infarct-related artery stenosis (SYNTAX score ≥2.5) was an independent predictor of major adverse cardiac events (HR 2.15).
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