Correlation between NSTE-ACS risk scores with Syntax: can we predict coronary lesion complexity before angiography?

Autor: S Maltes, M S Paiva, S Madeira, R C Teles, M S Almeida, M Mendes
Rok vydání: 2022
Předmět:
Zdroj: European Heart Journal. 43
ISSN: 1522-9645
0195-668X
Popis: Background and aim Standard single antiplatelet regimen (SAPT) is currently recommended before invasive risk stratification in non-ST elevation acute coronary syndromes (NSTE-ACS). However, there are subsets in whom dual antiplatelet therapy (DAPT) may be more protective according to the coronary anatomy and revascularization strategy. We aimed to identify pre-procedural predictors of coronary artery complexity that may be helpful in selecting an individualized antiplatelet regimen. Methodology Retrospective single-center study including patients with NSTE-ACS performing coronary angiography between January 2020 and July 2021. Clinical variables and classical NSTE-ACS risk scores (TIMI, GRACE and HEART) were captured and SYNTAX 1 score was calculated. Patients were divided into low (0–22), moderate (23–32) and high (≥33) SYNTAX score. Multivariate logistic regression analysis was performed to determine predictors of anatomical complexity (defined as significant left main disease [stenosis ≥50%] or SYNTAX ≥33). Results A total of 448 patients were included (mean age 67±13 years; 74% males; 85% with NSTE-myocardial infarction). Overall, 350 (78%), 63 (14%) and 35 (8%) patients had a low, moderate or high-SYNTAX score, respectively. Thirty-one (7%) patients had significant left main disease. At multivariate analysis (adjusted for age, diabetes, renal function, GRACE and TIMI scores), the HEART score (hazard ratio 2.3, 95% confidence interval 1.5–3.3, p7 showed a sensitivity of 76% and specificity of 75% in identifying such patients. Conclusion In this cohort of NSTE-ACS patients, the HEART score was an independent predictors of complex coronary anatomies. These results suggest that those with high (>7) HEART score may merit from SAPT as opposed to DAPT, given the high probability of complex lesions amenable to CABG. Funding Acknowledgement Type of funding sources: None.
Databáze: OpenAIRE
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