The SYNTAX Score and Distal Embolization during Primary Percutaneous Coronary Intervention

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.