Background: The Syntax Score (SxS) is a scoring system for the complexity of atherosclerotic disease burden in the coronary arteries. We investigated the predictive value of the SxS for the occurrence of a periprocedural myocardial infarction (PMI) according to the WHO definition and recently updated third universal definition of MI.
Methods: The SxS was calculated in 1,243 patients enrolled in TWENTE, a randomised trial in a real-world patient population treated with second-generation drug-eluting stents. In all patients, cardiac biomarkers and electrocardiograms were systematically assessed. PMI (i.e. an MI within 48 hours after PCI) was defined by the extended historical WHO definition and the third universal definition of MI.
Results: Patients were stratified in tertiles of SxS ≥15 (n=423), >7 and <15 (n=390), and <=7 (n=430). PMI according to the WHO definition occurred more frequently in patients of the highest SxS tertile group than in other tertile groups (7.3% vs. 3.1% vs. 1.6%, p<0.001). Similar findings were also seen for PMI according to the universal definition (9.9% vs. 7.7% vs. 3.7%, p<0.01). The SxS was a significant independent predictor of PMI according to both historical (adjusted OR 1.07, 95% CI: 1.04-1.10, p<0.001) and universal definition (adjusted OR 1.04, 95% CI: 1.01-1.06 p<0.001). In addition, 2-year all-cause mortality differed between SxS tertile groups (6.6% vs. 4.1% vs. 1.4%; p=0.001).
Conclusions: In a real world patient population treated with second-generation drug-eluting stents, the Syntax Score was able to stratify risk for the occurrence of periprocedural MI and all-cause mortality.