SYNTAX score is a predictor of angiographic no-reflow in patients with ST-elevation myocardial infarction treated with a primary percutaneous coronary intervention

• Published in: Coronary artery disease Vol. 24; no. 2; pp. 148 - 153
• Main Authors: Şahin, Durmuş Y, Gür, Mustafa, Elbasan, Zafer, Kuloğlu, Osman, Şeker, Taner, Kivrak, Ali, Tanboğa, İbrahim H, Gözübüyük, Gökhan, Kirim, Sinan, Çayli, Murat
• Format: Journal Article
• Language: English
• Published: England Lippincott Williams & Wilkins, Inc 01-03-2013
• Subjects: Age Factors; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Stenosis - diagnostic imaging; Coronary Thrombosis - classification; Coronary Thrombosis - diagnostic imaging; Diabetes Mellitus - epidemiology; Female; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - therapy; No-Reflow Phenomenon; Percutaneous Coronary Intervention; Prospective Studies; Risk Assessment; ROC Curve; Sensitivity and Specificity; Severity of Illness Index
• ISSN: 0954-6928; 1473-5830
• DOI: 10.1097/MCA.0b013e32835c4719

OBJECTIVESThe no-reflow phenomenon has a negative prognostic value in patients with acute ST-elevation myocardial infarction (STEMI). The SYNTAX score (SS) quantifies the extent and complexity of angiographic disease and predicts long-term mortality and morbidity in STEMI. We aimed to assess the no-reflow and its possible relationships with SS and clinical characteristics in patients with STEMI treated with a primary percutaneous coronary intervention (PPCI).
MATERIALS AND METHODSIn this study, 880 patients with STEMI treated with PPCI were included prospectively (646 men and 234 women, mean age 58.5±12.4 years). The SS, thrombolysis in myocardial infarction (TIMI) flow grade score, and TIMI myocardial blush grade score were determined in all patients. No-reflow was defined as TIMI grade 0, 1 and 2 flows or TIMI grade 3 with myocardial blush grade 0 and 1. The patients were divided into two groupsa normal flow group and a no-reflow group.
RESULTSNo-reflow was observed in 32.8% of patients. The mean SS of the no-reflow group was higher than that of the normal flow group (19.2±6.8/12.9±6.1, P<0.001). On multivariate logistic regression analysis, SS [β=0.872, 95% confidence interval (CI)=0.845–0.899, P<0.001], diabetes (β=0.767, 95% CI=0.128–4.597, P=0.004), anterior myocardial infarction (β=5.421, 95% CI=1.369–21.469, P=0.025), and thrombus grade after wiring (β=2.537, 95% CI=1.506–4.273, P<0.001) were found to be independent predictors of no-reflow. The cutoff value of SS obtained by the receiver-operator characteristic curve analysis was 19.75 for the prediction of no-reflow (sensitivity70.6%, specificity69.4%).
CONCLUSIONThe SS is a predictor of no-reflow in patients with STEMI treated with PPCI.