V. Oduncu

Baseline SYNTAX Score and Long-Term Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objectives: The SYNTAX score (SXscore) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on the location and complexity of each lesion. The aim of this study was to evaluate whether the SXscore is an independent predictor of long-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2993 patients with acute STEMI who underwent primary PCI were stratified into the 4 groups according to the SXscore quartiles; quartile 1(Q1, SXscore ≤ 9, n = 819), Q2 (9 < SXscore < 16, n = 715), Q3 (16 ≤ SXscore < 20, n = 710), and Q4 (SXscore ≥ 20, n = 749). Results: There were significant differences among the quartiles with respect to age, basal creatinine and glucose levels, and the incidences of diabetes mellitus, Killip ≥2, and anemia. From Q1 to Q4, there were increasing rates of culprit left anterior descending lesion (P < .001), multivessel disease (P < .001), chronic total occlusion (P < .001), and proximal lesion localization (P < .001). At long-term follow-up, all-cause mortality, nonfatal myocardial infarction, stroke, rehospitalization due to heart failure, and the need of revascularization were significantly more frequent among the patients in the highest SXscore quartile. In multivariate analysis, after including the SXscore as a numerical variable into the model, every point of increase was determined as an independent predictor for long-term mortality (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = .008) and for overall major adverse cardiac events (MACEs; HR 1.02, 95% CI 1.01-1.04, P < .001). Conclusion: The SXscore is an independent predictor of both in-hospital and long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.

Neutrophil to lymphocyte ratio in acute ST-segment elevation myocardial infarction.

Background:Spontaneous early patency of infarct-related artery (IRA) on arrival for primary percutaneous coronary intervention is associated with better short- and long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to investigate whether the hemographic parameters on admission are associated with spontaneous IRA patency. Methods:This was a retrospective study of 1,625 patients with acute STEMI who underwent primary percutaneous coronary intervention <12 hours after the onset of symptoms. Results:Angiography showed patent IRA (prethrombolysis in myocardial infarction [TIMI] grade 3 flow) in 160 (9.8%) patients. Neutrophil count on admission (7.8 ± 2.4 × 103/&mgr;L versus 9.7 ± 3.8 × 103/&mgr;L; P < 0.001) was significantly lower and lymphocyte count (2.4 ± 1.0 × 103/&mgr;L versus 1.9 ± 1.1 × 103/&mgr;L; P < 0.001) on admission was significantly higher in the patent IRA group. Neutrophil to lymphocyte ratio (NLR) was significantly lower in the patent IRA group (4.1 ± 3.2 versus 6.9 ± 5.5; P < 0.001). Admission leukocyte counts (13 ± 4.0 × 103/&mgr;L versus 12 ± 3.4 × 103/&mgr;L; P < 0.001) and NLR (7.2 ± 5.8 versus 5.5 ± 4.4; P < 0.001) of the patients with TIMI thrombus score ≥4 were significantly higher than patients with TIMI thrombus score <4. In the multivariate analysis, NLR ≥4.5 (3.17 [95% confidence interval: 2.04–4.92]; P < 0.001) was found to be independently predicting an occluded IRA on initial angiography with a sensitivity of 62.7% and a specificity of 70%. Conclusions:NLR on admission is significantly related to angiographic thrombus burden and spontaneous early IRA patency in patients with acute STEMI.

Response to Immediate and Long-Term Results Following Balloon Mitral Valvotomy in Patients With Atrial Fibrillation

Mohanan Nair KK et al. Clin Cardiol. 2012;35:35–39