Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease

• Published in: BMC cardiovascular disorders 2024-01, Vol.24 (1), p.68-17, Article 68
• Main Authors: Ahmed, Tarek A N, Othman, Amr A A, Demitry, Salwa R, Elmaghraby, Khaled M
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Acute Myocardial Infarction; Angioplasty; Cardiology; Cardiovascular disease; Care and treatment; Complications and side effects; Coronary Artery Disease; Coronary vessels; Female; Heart; Heart attack; Heart attacks; Heart diseases; Hospital Mortality; Humans; Hypertension; Ischemia; Medical imaging; Medical prognosis; Mortality; Myocardial Infarction; Myocardial revascularization; Non-ST Elevated Myocardial Infarction; Patient outcomes; Patients; Percutaneous Coronary Intervention; Residual Coronary Artery Disease; Residual SYNTAX Score (rSS); Software; ST Elevation Myocardial Infarction; Stroke Volume; Survival analysis; SYNTAX Revescularization Index (SRI); Transluminal angioplasty; Vein & artery diseases; Ventricle; Ventricular Function, Left
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-023-03657-2

The residual burden of coronary artery disease (CAD) after percutaneous coronary intervention (PCI) drew a growing interest. The residual SYNTAX Score (rSS) was a strong prognostic factor of adverse events and all-cause mortality in patients who underwent PCI. In addition, the SYNTAX Revascularization Index (SRI), a derivative of rSS, was used to figure out the treated proportion of CAD and could be used as a prognostic utility in PCI for patients with multi-vessel disease (MVD). We aimed at the assessment of the use of rSS and the SRI as predictors of in-hospital outcomes and up to two-year cumulative follow-up outcomes in patients with MVD who had PCI for the treatment of ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI (NSTEMI). We recruited 149 patients who had either STEMI or NSTEMI while having MVD and received treatment with PCI. We divided them into tertiles based on their rSS and SRI values. We calculated baseline SYNTAX Score (bSS) and rSS using the latest version of the calculator on the internet, and we used both scores to calculate SRI. The study end-points were In-hospital composite Major Adverse Cardiovascular Events (MACE) and its components, in-hospital death, and follow-up cumulative MACE up to 2 years. Neither rSS nor SRI were significant predictors of in-hospital adverse events, while female sex, hypertension, and left ventricular ejection fraction were independent predictors of in-hospital MACE. At the two-year follow-up, Kaplan-Meyer analysis showed a significantly increased incidence of MACE within the third rSS tertile (rSS > 12) compared to other tertiles (log rank p = 0.03). At the same time, there was no significant difference between the three SRI tertiles. Unlike SRI, rSS was a significant predictor of cumulative MACE on univariate Cox regression (HR = 1.037, p  12 had a significantly higher incidence of cumulative MACE after 2 years. The best prognosis was achieved with complete revascularization.