PERIPROCEDURAL MYOCARDIAL NECROSIS PREDICTION BY SYNATX SCORE DURING PERCUTANOUS CORONARY INTERVENTION IN DIABETIC PATIENTS.

Abstract

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 and American Heart Association/American College of Cardiology (AHA/ACC) classification to predict PPI.
Methods: 60 patients with chronic stable angina not controlled by medical treatment were included from the day case PCI. Inclusion criteria; patients undergoing insertion of < 30 mm of stent to a single vessel and/or bifurcation PCI involving a side branch > 2.0 mm in diameter, and/or patients undergoing double vessel PCI. Exclusion criteria; Patients with heart failure and lesions > 30 mm in length, patients with high syntax high syntax score, Patients with coronary bypass grafts, previous PCI and patients with instent restenosis. PPI was defined as troponin T elevation (N 0.1 ng/mL) at 6–24 h post-PCI.
Results: Patients were classified according to presence or absence of diabetes mellitus (DM) into two groups; group I (non-diabetic patients DM; 33 patients, 23 males, 10 females, their age ranged from 42- 62 years with mean 50.2±5.3 years), group II (diabetic patients; 27 patients, 16 males, 11 females, their age ranged from 45 -65 years with mean age of 54.4±5.4 years).
Patients were reclassified according to syntax score into two groups; group A (with low score (0-22); 48 patients) & group B (with intermediate score (22-32); 12 patients).
The mean patient SXscore was higher in diabetic patients and non diabetic patients (22.6 vs. 12.4, p = 0.0001), Gensini score was significantly higher in diabetic patients (52.4 vs. 25.3, p = 0.15). Also mean PCI vessel SXscore was higher in vessels associated with PPI (12.1 vs. 7.6, p = 0.002), but not different for PCI vessel Gensini score (16.2 vs. 13.6, p = 0.42). No vessels with AHA type A lesions were associated with PPI. Higher AHA classification (B and C) were associated with PPI.
In total, 60 patients undergoing PCI to 77 vessels were included in the analysis, There were 43/60 (71.6%) patients who had myocardial injury. The incidence of PPI among diabetic patients was higher than non diabetic patients (24/27, 88.9% vs 19/33, 57.6% respectively) reflecting procedural complexity, (long lesion and total occlusion) more in diabetic patients. Indeed, the procedural complexity reflected by the mean patient SXscore was higher in the diabetic patients group than non diabetic patients undergoing day case PCI.
By ROC analysis, we found that a patient with high SXscore of ≥ 15 can be considered as predictor of PPI with a sensitivity of 95.3% and specificity of 88.2%.
Conclusion: Higher SXscores are predictive of myocardial injury, whilst AHA type A lesions have a high negative predictive value for PPI.
Keywords: coronary artery disease; PCI; Coronary stenting; PPI, Syntax score, Gensini score; AHA/ACC.