The MI SYNTAX score for risk stratification in patients undergoing primary percutaneous coronary intervention for treatment of acute myocardial infarction: A substudy of the COMFORTABLE AMI trial

Michael Magro, Lorenz Räber, Dik Heg, Masanori Taniwaki, Henning Kelbaek, Miodrag C. Ostojic, Andreas Baumbach, David Tüller, Clemens von Birgelen, Marco Roffi, Giovanni Pedrazzini, Ran Kornowski, Klaus Weber, Bernard Meier, Thomas F. Lüscher, Patrick W. Serruys, Peter Jüni, Stephan Windecker

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17 Citations (Scopus)

Abstract

Background To investigate the performance of the MI Sxscore in a multicentre randomised trial of patients undergoing primary percutaneous coronary intervention (PPCI). Methods and results The MI Sxscore was prospectively determined among 1132 STEMI patients enrolled into the COMFORTABLE AMI trial, which randomised patients to treatment with bare-metal (BMS) or biolimus-eluting (BES) stents. Patient- (death, myocardial infarction, any revascularisation) and device-oriented (cardiac death, target-vessel MI, target lesion revascularisation) major adverse cardiac events (MACEs) were compared across MI Sxscore tertiles and according to stent type. The median MI SXscore was 14 (IQR: 9–21). Patients were divided into tertiles of Sxscorelow (≤ 10), Sxscoreintermediate (11–18) and Sxscorehigh (≥ 19). At 1 year, patient-oriented MACE occurred in 15% of the Sxscorehigh, 9% of the Sxscoreintermediate and 5% of the Sxscorelow tertiles (p < 0.001), whereas device-oriented MACE occurred in 8% of the Sxscorehigh, 6% of the Sxscoreintermediate and 4% of the Sxscorelow tertiles (p = 0.03). Addition of the MI Sxscore to the TIMI risk score improved prediction of patient- (c-statistic value increase from 0.63 to 0.69) and device-oriented MACEs (c-statistic value increase from 0.65 to 0.70). Differences in the risk for device-oriented MACE between BMS and BES were evident among Sxscorehigh (13% vs. 4% HR 0.33 (0.15–0.74), p = 0.007 rather than those in Sxscorelow: 4% vs. 3% HR 0.68 (0.24–1.97), p = 0.48) tertiles. Conclusions The MI Sxscore allows risk stratification of patient- and device-oriented MACEs among patients undergoing PPCI. The addition of the MI Sxscore to the TIMI risk score is of incremental prognostic value among patients undergoing PPCI for treatment of STEMI.
Original languageEnglish
Pages (from-to)314-322
JournalInternational journal of cardiology
Volume175
Issue number2
DOIs
Publication statusPublished - 2014

Keywords

  • METIS-307081
  • IR-93178
  • Primary percutaneous coronary intervention
  • ST segment elevation myocardial infarction
  • SYNTAX score

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