SCORE2-diabetes predicts coronary complexity assessed by SYNTAX score in diabetic patients with first myocardial infarction

Background Risk stratification in patients with diabetes mellitus (DM) remains challenging. Whether SCORE2-Diabetes, a primary prevention risk score, reflects coronary anatomy and clinical outcomes at first myocardial infarction (MI) is insufficiently explored. Purpose To evaluate the association between SCORE2-Diabetes, coronary disease complexity assessed by SYNTAX score, and 1-year mortality, in diabetic patients presenting with a first MI. Methods We retrospectively analyzed 301 consecutive patients with DM admitted for first MI (either STEMI or NSTEMI) in a tertiary university hospital. Patients with previously known atherosclerotic cardiovascular disease were excluded. SCORE2-Diabetes was calculated post-hoc, immediately prior to MI, and categorized as <10%, 10-20%, and >20%. Coronary complexity was assessed using the SYNTAX score (≤22, 23-32, ≥33). One-year all-cause mortality was recorded. Multivariable logistic regression was used to identify predictors of high coronary complexity and mortality. Results Higher SCORE2-Diabetes categories were associated with increasing coronary complexity. Patients with SCORE2-Diabetes >20% showed a significantly higher prevalence (48.6% vs 15.1%, p<0.001) of high SYNTAX scores (≥33) compared with lower-risk groups. By multivariable logistic regression, SCORE2-Diabetes ≥20% independently predicted high coronary complexity after adjustment for sex, diabetes duration, and HbA1c at admission (OR 1.14, 95% CI 1.06–1.24; p = 0.009). At 1 year, all-cause mortality was 18.7%. Mortality increased stepwise with coronary complexity; Kaplan–Meier survival analysis (Figure 1) demonstrated a markedly reduced survival probability in the high SYNTAX group score > 33 compared with < 33 (63.4% vs 89.4% at 1 year; log-rank p<0.001). Cox proportional hazards analysis showed that SYNTAX >33 was associated with a 3.4-fold increased risk of all-cause mortality (HR ≈3.4). By multivariable analysis, coronary complexity assessed by SYNTAX score remained an independent predictor of 1-year mortality, together with reduced left ventricular ejection fraction <40% and incomplete revascularization (all p<0.05). Conclusion In diabetic patients presenting with a first MI, SCORE2-Diabetes identifies individuals with more complex coronary anatomy. Coronary complexity, in turn, drives 1-year mortality. Risk assessment in diabetic patients is essential, since it predicts both coronary anatomy and prognosis of first MI.