Usefulness of the SYNTAX Score to Predict “No Reflow” in Patients Treated With Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

• Published in: The American journal of cardiology Vol. 109; no. 5; pp. 601 - 606
• Main Authors: Magro, Michael, MD, Nauta, Sjoerd T., MSc, Simsek, Cihan, MD, Boersma, Eric, PhD, van der Heide, Elco, MSc, Regar, Evelyn, MD, PhD, van Domburg, Ron T., PhD, Zijlstra, Felix, MD, PhD, Serruys, Patrick W., MD, PhD, van Geuns, Robert Jan, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2012; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Clinical outcomes; Coronary Angiography - methods; Coronary heart disease; Coronary vessels; Diseases of the cardiovascular system; Electrocardiography; Female; Follow-Up Studies; Heart; Heart attacks; Humans; Incidence; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Netherlands - epidemiology; No-Reflow Phenomenon - diagnostic imaging; No-Reflow Phenomenon - epidemiology; No-Reflow Phenomenon - prevention & control; Odds Ratio; Predictive Value of Tests; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Regression analysis; Retrospective Studies; Risk Assessment - methods; Risk Factors; Treatment Outcome; Human; Myocardial infarction; Atherectomy; Angioplasty; Coronary artery; Instrumentation therapy; Cardiovascular disease; Patient; Coronary heart disease; Myocardial disease; Stent; Percutaneous route; ST elevation; Primary; Circulatory system; Cardiology; Predictive factor
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2011.10.013

The no-reflow phenomenon has been shown to have a significant effect on clinical outcomes in patients with acute ST-segment elevation myocardial infarction. Angiographic features incorporated in the SYNTAX Score (SXScore) obtained on diagnostic angiography during primary percutaneous coronary intervention (PPCI) may be associated with the occurrence of myocardial no-reflow. The aim of this study was to assess the ability of the SXScore to predict no-reflow during PPCI. The SXScore was applied to 669 consecutive patients presenting with acute ST-segment elevation myocardial infarction from November 2006 to February 2008. Angiographic analysis of the PPCI procedure was used to determine no-reflow. The median SXScore was 16 (range 9.5 to 23). No-reflow occurred in 77 patients (12%). On univariate logistic regression analysis, the SXScore showed a strong association (for each 10-unit increase in SXScore, odds ratio 1.42, 95% confidence interval 1.16 to 1.76, p <0.001). On multivariate logistic regression in a model including clinical variables, SXScore was an independent predictor of no-reflow (odds ratio 1.29, 95% confidence interval 1.02 to 1.63, p <0.001). Classification and regression tree analysis identified SXScore >21 as the best cutoff, with patients having double the risk for no-reflow compared to those with SXScore ≤21 (events 9% vs 18%, p = 0.006). In conclusion, the SXScore obtained in the diagnostic phase of PPCI for acute ST-segment elevation myocardial infarction can identify patients at risk for developing no-reflow.