Association of SYNTAX score with myocardial injury in STEMI patients: a cardiac magnetic resonance study

Abstract

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.