PROGNOSTIC ROLE OF INITIAL AND RESIDUAL SEVERITY OF CORONARY ATHEROSCLEROSIS IN MYOCARDIAL IN FARCTION PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

The aim of this study was to investigate the prognostic role of initial and residual severity of coronary atherosclerosis by SYNTAX SCORE among ST segment elevation myocardial infarction patients (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Materials and methods. The study included 327 STEMI patients with multivessel coronary atherosclerosis who underwent primary PCI. Two groups were formed to study the prognostic value of initial coronary atherosclerosis severity: SYNTAX ≤22 points (n=213) and SYNTAX ≥23 points (n=114). 317 patients included in the second sub-analysis (the study of the prognostic role of residual severity of coronary atherosclerosis). The patients were divided into two groups, depending on the residual SYNTAX SCORE after primary PCI: ≤8 points (n=243) and ≥9 points (n=74). The endpoints of the study were adverse cardiovascular events over 12 months.

Results. The initial value of SYNTAX ≥23 points led to a significant increase in the rate of death, myocardial infarction (MI) and stent thrombosis (ST) as well as the combined endpoint. The most significant adverse events during the 12 months of observation, associated with the severity of coronary lesions on the SYNTAX ≥23 are: 1) death from any cause – OR 4.9 (95 % CI, p=0.004); 2) cardiac death – OR 5.6 (95 % CI, p=0.004); 3) MI – OR 3.5 (95 % CI, p=0.01); 4) The combined endpoint – OR 2.4 (95 % CI, p=0.05); 5) ST – 5 OR (95 % CI, p=0.007). The group of residual SYNTAX ≥9 in comparison with the group SYNTAX ≤8 characterized by less favorable prognosis, which was reflected in a higher frequency of death from all causes – 13.5 % vs. 2.9 % (p=0.001), OR 3.4 (1,5–7,9 95 % CI) (p=0.004), MI – 10.8 % versus 4.1 % (p=0.05), OR 2.7 (1.2–6.1; 95 % CI) (p=0.01), non-target vessel revascularization – 9.5 % versus 2.5 % (p=0.02), OR 2.6 (1.2–5.5; 95 % CI) (p=0.01).

Conclusions. It was demonstrated the high predictive value of initial and residual severity of coronary lesions by SYNTAX SCORE to influence the risk of adverse cardiovascular events in patients undergoing primary PCI. The results obtained may find application in the development of predictive models aimed at determining the optimal strategies revascularization for patients with STEMI in multiple coronary atherosclerosis.

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