Prognostic impact of baseline and residual SYNTAX scores in cardiogenic shock
Por:
Javanainen, T, Sans-Rosello, J, Harjola, VP, Nieminen, MS, Lassus, J, Sionis, A, Varpula, M, Jurkko, R
Publicada:
1 ene 2019
Resumen:
Objectives The aim was to assess the extent of coronary artery disease and revascularization using baseline SYNTAX Score (bSS) and residual SYNTAX Score (rSS) in patients with cardiogenic shock (CS) secondary to ST-segment elevation myocardial infarction (STEMI). The prognostic impact of SYNTAX Score (SS) was evaluated and assessed for additive value over clinical risk scores. Background bSS and rSS have been proven to be useful in risk stratification in stable coronary artery disease as well as in acute coronary syndromes, but they have not been studied in STEMI related CS. Methods Patients from a multinational prospective study of CS were analyzed. The study population was divided into tertiles according to bSS. The Cox regression and receiver operating characteristic (ROC) curves were used to assess the predictive power of SS. Results Of the 61 studied patients, 85% were male and the mean age was 67 years. Median bSS was 22 (15-32) and rSS 7 (0-13). Ninety-day mortality was 43%. bSS had negative prognostic value in multivariable analysis (HR 1.06, 95% CI 1.01-1.10). However, additive value over clinical risk scores was limited. rSS was not associated with mortality, whereas post-percutaneous coronary intervention (PCI) TIMI flow 3 of infarct-related artery (IRA) predicted better survival. Conclusions In STEMI related CS, the added value of bSS and rSS over clinical assessment and risk scores is limited. Our results suggest that while immediate PCI in order to restore blood flow to the IRA is essential, deferring the treatment of residual lesions does not seem to be associated with worse prognosis.
Filiaciones:
Javanainen, T:
Univ Helsinki, Helsinki Univ Hosp, Heart & Lung Ctr, Cardiol, Helsinki, Finland
Sans-Rosello, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau,CIBER CV, Dept Cardiol,Acute & Intens Cardiovasc Care Unit, Barcelona, Spain
Harjola, VP:
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Med & Serv, Emergency Med, Helsinki, Finland
Nieminen, MS:
Univ Helsinki, Helsinki Univ Hosp, Heart & Lung Ctr, Cardiol, Helsinki, Finland
Lassus, J:
Univ Helsinki, Helsinki Univ Hosp, Heart & Lung Ctr, Cardiol, Helsinki, Finland
Sionis, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau,CIBER CV, Dept Cardiol,Acute & Intens Cardiovasc Care Unit, Barcelona, Spain
Varpula, M:
Univ Helsinki, Helsinki Univ Hosp, Heart & Lung Ctr, Cardiol, Helsinki, Finland
Jurkko, R:
Univ Helsinki, Helsinki Univ Hosp, Heart & Lung Ctr, Cardiol, Helsinki, Finland
Green Published
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