Author + information
- Hidenori Adachi,
- Yoshinori Yasuoka,
- Kiyoshi Kume,
- Susumu Hattori,
- Yoshiki Noda,
- Ryo Araki,
- Ryo Matsutera,
- Motohiro Kosugi,
- Yasuaki Kohama,
- Tetsufumi Nakashima and
- Tatsuya Sasaki
The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) is a good predictor of adverse cardiovascular events and mortality in patients with acute coronary syndrome (ACS). The utility of risk stratifying patients with ACS complicated by cardiogenic shock using the SS remains unknown. Our objective was to examine whether the residual SS (RSS) would predict short-term outcomes in patients with ACS complicated by cardiogenic shock and improve the predictive ability for them better than the baseline SS (BSS).
The BSS was calculated retrospectively by scoring all coronary lesions in 59 consecutive patients with ACS complicated by cardiogenic shock from September 2007 to April 2012. The RSS was calculated by scoring all residual coronary lesions after primary percutaneous coronary intervention (PPCI) performed. The predictive accuracy of RSS and BSS was evaluated using C statistic from the receiver operator curves. Clinical outcomes of all-cause death were stratified according to RSS >15 or ≤15.
The C statistic of RSS was significantly higher compared to that of BSS regarding 30-day (0.85 [95% confidence interval 0.73 to 0.93] vs. 0.73 [95% confidence interval 0.59 to 0.83], p = 0.021) and 6-month all-cause mortality (0.86 [95% confidence interval 0.75 to 0.94] vs. 0.75 [95% confidence interval 0.62 to 0.86], p = 0.031). RSS of 15 was identified as the optimal cut-off to predict 30-day and 6-month mortality. Prognostic value of the RSS >15 was an independent predictor of 30-day (hazard ratio 6.43, 95% confidence interval 1.39 to 29.8, p = 0.018) and 6-month mortality (hazard ratio 8.02, 95% confidence interval 2.24 to 28.8, p = 0.002) assessed by Cox regression analysis. The rates of all-cause death were significantly increased in patients in the RSS >15 group, both within the first 30 days after PPCI and between 30 days and 6 months.
These data suggest that the RSS predicts short-term outcomes in patients with ACS complicated by cardiogenic shock and improves the predictive ability for them better than BSS.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: MI Complications: Shock, Arrest and Cardiac Rupture
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1126-180
- 2013 American College of Cardiology Foundation