TY - JOUR
T1 - The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention
AU - van Gaal, William J.
AU - Ponnuthurai, Francis A.
AU - Selvanayagam, Joseph
AU - Testa, Luca
AU - Porto, Italo
AU - Neubauer, Stefan
AU - Banning, Adrian P.
PY - 2009/6/12
Y1 - 2009/6/12
N2 - Background: Peri-procedural myocardial injury (PPI) during percutaneous coronary intervention (PCI) is common and associated with a poor outcome. No reliable angiographic or clinical predictors of PPI exist. We evaluated the ability of the SYNTAX score (SXscore), Gensini score, American Heart Association/American College of Cardiology (AHA/ACC) and Society for Cardiovascular Angiography and Intervention (SCAI) classifications to predict PPI. Methods: Consecutive patients were included from two existing databases of PCI. Patients with coronary bypass grafts or instent restenosis were excluded. PPI was defined as troponin I elevation (> 1.0 μg/L) at 6-24 h post-PCI. Delayed enhancement magnetic resonance imaging distinguished PPI territory in patients undergoing multi-vessel PCI. Quantitative coronary angiography was performed blinded to PPI. In total, 100 patients underwent PCI to 122 vessels. PPI occurred in 20/100 (20.0%) patients. Results: Mean patient SXscore was higher in patients with PPI (20.6 vs. 12.4, p = 0.0001), however Gensini score was not significantly different (34.2 vs. 27.3, p = 0.15). Mean vessel SXscore was higher in vessels associated with PPI (12.1 vs. 7.6, p = 0.002), but not different for vessel Gensini score (16.2 vs. 13.6, p = 0.42). No vessels with AHA type A or B1 lesions were associated with PPI. Higher AHA scores (B2 and C) were associated with PPI (χ2 for trend 11.6, p = 0.0007). SCAI scores were not predictive of PPI (χ2 for trend 3.6, p = 0.06). By ROC analysis, a patient SXscore of ≥ 17 predicted PPI with a sensitivity of 75.0% and specificity of 70.0%. Conclusion: Higher SXscores are predictive of myocardial injury, whilst AHA type A and B1 lesions have a high negative predictive value for PPI.
AB - Background: Peri-procedural myocardial injury (PPI) during percutaneous coronary intervention (PCI) is common and associated with a poor outcome. No reliable angiographic or clinical predictors of PPI exist. We evaluated the ability of the SYNTAX score (SXscore), Gensini score, American Heart Association/American College of Cardiology (AHA/ACC) and Society for Cardiovascular Angiography and Intervention (SCAI) classifications to predict PPI. Methods: Consecutive patients were included from two existing databases of PCI. Patients with coronary bypass grafts or instent restenosis were excluded. PPI was defined as troponin I elevation (> 1.0 μg/L) at 6-24 h post-PCI. Delayed enhancement magnetic resonance imaging distinguished PPI territory in patients undergoing multi-vessel PCI. Quantitative coronary angiography was performed blinded to PPI. In total, 100 patients underwent PCI to 122 vessels. PPI occurred in 20/100 (20.0%) patients. Results: Mean patient SXscore was higher in patients with PPI (20.6 vs. 12.4, p = 0.0001), however Gensini score was not significantly different (34.2 vs. 27.3, p = 0.15). Mean vessel SXscore was higher in vessels associated with PPI (12.1 vs. 7.6, p = 0.002), but not different for vessel Gensini score (16.2 vs. 13.6, p = 0.42). No vessels with AHA type A or B1 lesions were associated with PPI. Higher AHA scores (B2 and C) were associated with PPI (χ2 for trend 11.6, p = 0.0007). SCAI scores were not predictive of PPI (χ2 for trend 3.6, p = 0.06). By ROC analysis, a patient SXscore of ≥ 17 predicted PPI with a sensitivity of 75.0% and specificity of 70.0%. Conclusion: Higher SXscores are predictive of myocardial injury, whilst AHA type A and B1 lesions have a high negative predictive value for PPI.
KW - Coronary artery disease
KW - Coronary stenting
KW - Myocardial infarction
KW - PTCA
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U2 - 10.1016/j.ijcard.2008.03.033
DO - 10.1016/j.ijcard.2008.03.033
M3 - Article
C2 - 18582969
AN - SCOPUS:67349275356
VL - 135
SP - 60
EP - 65
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 1
ER -