STEMI | Acta Medica Marisiensis

Introduction: Multivessel disease has a major impact on reperfusion in acute myocardial infarction with ST segment elevation (STEMI), as well as on patients’ prognostic after primary percutaneous coronary intervention (PCI). Concurrently with the invasive treatment, a precise description of the coronary anatomy is obtained. However, there is only one scoring system based just on anatomy to appreciate the prognosis after PCI – the SYNTAX score (SXS) – and it was recently validated for STEMI cases. The relationship between the SXS and myocardial reperfusion has not been studied till now.
Material and methods: A retrospective study was performed including cases admitted with STEMI between 01 January 2010–31 January 2011. The SXSs were calculated. As a surrogate for reperfusion, ST segment resolution after angioplasty was measured and compared between the low, medium and high SXS tertiles. Total in-hospital mortality was also evaluated as a function of the SXS score.
Results: Eighty-four patients were enrolled in the study. The groups with low, medium and high values of SXS were homogenous with regard to: age, sex, presence of arterial hypertension, diabetes, smoking, ischemic period, pre- and postprocedural thrombolysis in myocardial infarction (TIMI) flow. However, mean ejection fraction was significantly lower in medium or high SXS tertiles (p < 0.05). Medium and high values of SXS were significantly associated with poor ST segment resolution, as well as a higher in-hospital mortality (p < 0.05).
Conclusion: Complex coronary anatomy has a negative influence on the short-term prognosis of STEMI, possibly partially by poor reperfusion, in spite of achieving a good epicardial flow.

Introduction: Multivessel disease, as well as complex coronary anatomy – characterized by high values of the SYNTAX score – has a major impact on reperfusion and patients’ prognostic after an acute myocardial infarction with ST segment elevation (STEMI). Distal embolization, one of the main procedural complications of primary percutaneous coronary intervention (pPCI) could explain this association. However, the relationship between the SYNTAX score and distal embolization has not been studied till now.
Material and methods: A prospective clinical study was performed including all of the cases admitted with STEMI between january 1, 2011 and December 31, 2011. The SYNTAX scores were calculated and distal embolization was appreciated using the recordings of emergency coronary angiographies and pPCI procedures. Statistical analysis was performed, if the SYNTAX score values were higher or not in the cases with distal embolization.
Results: One hundred and thirty-seven patients were enrolled in the study. Distal embolization was present in 45 cases (32.8%); the calculated SYNTAX score values (range: 3 to 42) were significantly higher in these patients (p=0.0035).
Conclusion: Complex coronary anatomy, defined by higher SYNTAX score values, seems to be a contributing factor to distal embolization, determining a negative influence on myocardial reperfusion and subsequently on the prognosis of STEMI.