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The aim of this study was to investigate the prognostic role of initial and residual severity of coronary atherosclerosis in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).
We recruited 327 consecutive patients with STEMI and multivessel coronary artery disease (MVCAD) who underwent primary PCI. We then assessed the severity of coronary atherosclerosis using coronary angiography and SYNTAX score. All patients were further stratified into two groups: 1) SYNTAX ≤ 22 points (n = 213); 2) SYNTAX ≥ 23 points (n = 114). Out of 327 patients included into initial analysis, 317 underwent the secondary coronary angiography to assess the residual severity of coronary atherosclerosis after primary PCI. The patients were again divided into two groups: 1) ≤ 8 points (n = 243); 2) ≥ 9 points (n = 74). Major adverse cardiovascular events within 1 year of follow-up were considered as the study endpoints.
Severe coronary atherosclerosis (SYNTAX ≥ 23 points) was significantly associated with a 4.9- and 5.6-fold increased risk of death from all causes and cardiac death, respectively. Moreover, it was significantly associated with a 3.5-, 5-, and 2.4-fold higher risk of MI, stent thrombosis, and combined endpoint, respectively. Higher residual coronary atherosclerosis (SYNTAX ≥ 9 points) was associated with a 3.4-, 2.7, and 2.6-fold higher risk of death from all causes, MI, and repeated non-target vessel revascularization compared to SYNTAX ≤ 8 points.
Both initial and residual high SYNTAX score are able to predict the risk of major adverse cardiovascular events in patients with STEMI and MVCAD who underwent primary PCI.
CORONARY: Acute Myocardial Infarction