Background SYNTAX score (SS) was shown to positively correlate with postprocedural myocardial injury in patients after elective coronary artery intervention, but evidence about the association of SS with myocardial salvage in ST-segment elevation myocardial infarction (STEMI) patients is still needed. This study aimed to evaluate the prognostic value of SS for myocardial injury and salvage assessed by cardiac magnetic resonance (CMR) after primary percutaneous coronary intervention (PCI) in STEMI patients. Methods This single-center retrospective study consecutively enrolled STEMI patients who had undergone primary PCI within 12 h from symptom onset. Both angiography and CMR were performed during hospitalization, and patients were divided into low SS (SS ≤ 22), mediate-high SS (SS > 22) groups. Correlation and multivariable analyses were performed. Results A total of 149 STEMI patients (96 low SS, 53 mediate-high SS) were included. In terms of myocardial injury parameters, there was a positive correlation (p < 0.001, Spearman r = 0.292) between SS and infarct size (IS), and a negative correlation (p < 0.001, Spearman r =  − 0.314) between SS and myocardial salvage index (MSI). In the multivariable model, SS (> 22 as categorical variable, OR = 2.245, 95% CI [1.002–5.053], p = 0.048; as continuous variable, OR = 1.053, 95% CI [1.014–1.095], p = 0.008) was significantly associated with high IS (≥ mean 35.43). The areas under the receiver operating characteristic (ROC) curves of SS for high IS and low MSI (≤ median 28.01) were 0.664 and 0.610. Conclusions In STEMI patients undergoing primary PCI, SYNTAX score positively correlated with infarct size and negatively with myocardial salvage, indicating an independent predictive value of the myocardial injury.

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SYNTAX score (SS) is positively correlated with postprocedural myocardial injury identified by high sensitivity cardiac troponin in patients undergone elective coronary artery intervention, evidences about the association of SS with myocardial injury in STEMI patients were still scarce. A total of 149 consecutive patients within 24 h of STEMI were enrolled in the study. Both angiography and cardiac magnetic resonance (CMR) were performed during hospitalization. The time was 7.05 h (4.44,95.91, IQR) from symptom to angiography and 7.31 ± 2.60 days from symptom to CMR. The total median SS was 17(9–25, IQR). In terms of myocardial injury parameters, there was a positive correlation between SS and infarct size (IS) (p < 0.001, Spearman r = 0.292), and negative correlation between SS and myocardial salvage index (MSI) (p < 0.001, Spearman r=-0.314). There was no significant correlation between SS and area at risk, microvascular obstruction or intramyocardial hemorrhage. According to SS, patients were divided into low SS (< 22) (LSS)(n = 96) or mediate-high SS (≥ 22) (MHSS)(n = 53) group. In the multivariable model, after adjustment for important known predictors of IS, MHSS was significantly associated with high IS (≥ mean 35.43) (odd ratio = 2.245, 95% confidence interval [1.002–5.053], p = 0.048), as a continuous variate, SS was also significant associated with high IS (odd ratio = 1.053, 95% confidence interval [1.014–1.095], p = 0.008). The areas under the receiver operating characteristic curves of SS for high IS and low MSI were 0.664 and 0.610. Conclusion: of STEMI patients who presented to hospital within 24h from symptom onset, SS was positively related with IS and negatively with MSI. SS was an independent predictor of IS after adjusting for important covariates.