Cardiogenic Shock, the Residual SYNTAX Score, and Prognosis

Objectives. The study evaluated the correlation between baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) on an unprotected left main coronary artery lesion (UPLMCA). Background. Previous studies on primary PCI in UPLMCA have identified cardiogenic shock, TIMI 0/1 flow, and cardiac arrest, as prognostic factors of an unfavourable outcome, but the complexity of coronary artery disease and the extent of revascularization have not been thoroughly investigated in these high-risk patients. Methods. 30-day, 1-year, and long-term outcomes were analyzed in a cohort of retrospectively selected, 81 consecutive patients with STEMI, and primary PCI on UPLMCA. Results. Cardiogenic shock (p=0.001), age (p=0.008), baseline SYNTAX Score II (p=0.006), and SYNTAX Revascularization Index (p=0.046) were independent mortality predictors at one-year follow-up. Besides cardiogenic shock (HR 3.28, p<0.001), TIMI 0/1 flow (HR 2.17, p=0.021) and age (HR 1.03, p=0.006), baseline SYNTAX Score II (HR 1.06, p=0.006), residual SYNTAX Score (HR 1.03, p=0.041), and SYNTAX Revascularization Index (HR 0.9, p=0.011) were independent predictors of mortality at three years of follow-up. In patients with TIMI 0/1 flow, the presence of Rentrop collaterals was an independent predictor for long-term survival (HR 0.24; p=0.049). Conclusions. In this study, the complexity of coronary artery disease and the extent of revascularization represent independent mortality predictors at long-term follow-up.

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Could Residual SYNTAX Score Predict the Prognosis of Patients With Cardiogenic Shock?

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2021.02.069 ◽

2021 ◽

Vol 77 (22) ◽

pp. 2872

Author(s):

Xiaofei Li ◽

Shimao Ni

Keyword(s):

Cardiogenic Shock ◽

Syntax Score ◽

Residual Syntax Score

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THE RESIDUAL SYNTAX SCORE FOR MORTALITY RISK ASSESSMENT IN ACUTE CORONARY SYNDROME WITH CARDIOGENIC SHOCK

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)60021-2 ◽

2013 ◽

Vol 61 (10) ◽

pp. E20 ◽

Cited By ~ 1

Author(s):

Hidenori Adachi ◽

Yoshinori Yasuoka ◽

Kiyoshi Kume ◽

Susumu Hattori ◽

Yoshiki Noda ◽

...

Keyword(s):

Risk Assessment ◽

Acute Coronary Syndrome ◽

Cardiogenic Shock ◽

Mortality Risk ◽

Syntax Score ◽

Coronary Syndrome ◽

Residual Syntax Score

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P3124Predictive value of the residual SYNTAX score following primary PCI in multivessel patients with MI-related cardiogenic shock - a CULPRIT SHOCK sub-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0199 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O Barthelemy ◽

S Rouanet ◽

D Brugier ◽

N Vignoles ◽

B Bertin ◽

...

Keyword(s):

Cardiogenic Shock ◽

Primary Endpoint ◽

Circulatory Support ◽

Syntax Score ◽

Complete Revascularization ◽

Prognostic Impact ◽

Primary Pci ◽

Culprit Lesion ◽

Coronary Syndrome ◽

Residual Syntax Score

Abstract Background Complete revascularization (CR) – assessed by the residual SYNTAX score (rSS) – following PCI is associated with a better prognosis – in stable coronary disease, acute coronary syndrome and myocardial infarction (MI). Whether, the completeness of revascularization impacts the prognosis of patients in cardiogenic shock (CS) remains unclear. Aim Assess the prognosis value of rSS following primary PCI in multivessel patients undergoing MI-related CS. Methods The CULPRIT SHOCK trial – the largest randomized trial (n=706) to date in CS – compared an immediate multivessel PCI (MVPCI) strategy to a culprit lesion only PCI (with possible staged revascularization) strategy in multivessel patients with MI-related CS. The rSS were retrospectively assessed following last PCI (either index or staged) by a central core laboratory and patients were allocated in 4 different groups according to rSS: CR (rSS=0), 0< rSS ≤5, 5< rSS ≤14, rSS >14. The prognostic impact of rSS on the 30-day composite endpoint (mortality and/or severe renal failure) and 30-day and 1-year mortality were assessed using multivariate logistic regression. Results Among the 604 patients with last rSS available, aged 68.2±11.4, the median rSS was 9.0 [4.0–17.0]. CR was achieved in 75 (25%) patients in the MVPCI strategy and in 31 (10.2%) in the culprit lesion only PCI strategy. One hundred and six (17.5%), 102 (16.9%), 198 (32.8%) and 198 (32.8%) patients had a rSS=0, 0< rss ≤5, 5< rSS ≤14 and rSS >14, respectively. Patients with a higher rSS were older, less active smoker, had more triple vessel disease, chronic total occlusion, post-PCI culprit coronary TIMI flow <3 and require more mechanical circulatory support and catecholamine. Univariate analysis shows a stepwise increase in adverse events according to rSS: patients with 5< rss ≤14 and rSS >14 had higher rates of 30-day primary endpoint (OR [95% CI]: 2.02 [1.24; 329] and 2.75 [1.69; 4.49]), 30-day mortality (OR [95% CI]: 2.13 [1.29; 3.51] and 3.14 [1.90; 5.18]) and 1-year mortality (OR [95% CI]: 2.39 [1.46; 3.90] and 3.47 [2.11; 5.71]) compared to patients with CR. After multiple adjustment, rSS – tested as continuous variable – was independently associated with 30-day primary endpoint, 30-day and one-year mortality (Figure) Conclusion Among multivessel patients with MI-related cardiogenic shock, 1) complete revascularization is achieved only in one fourth of the patients using a MVPCI strategy and, 2) the residual SYNTAX score is independently associated with early and late mortality. Acknowledgement/Funding Funded by the European Union 7th Framework Program and others

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Predictive Value of the Residual SYNTAX Score in Patients With Cardiogenic Shock

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2020.11.025 ◽

2021 ◽

Vol 77 (2) ◽

pp. 144-155 ◽

Cited By ~ 1

Author(s):

Olivier Barthélémy ◽

Stéphanie Rouanet ◽

Delphine Brugier ◽

Nicolas Vignolles ◽

Benjamin Bertin ◽

...

Keyword(s):

Cardiogenic Shock ◽

Predictive Value ◽

Syntax Score ◽

Residual Syntax Score

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Complete Revascularisation in Impella-Supported Infarct-Related Cardiogenic Shock Patients Is Associated With Improved Mortality

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.678748 ◽

2021 ◽

Vol 8 ◽

Author(s):

Andreas Schäfer ◽

Ralf Westenfeld ◽

Jan-Thorben Sieweke ◽

Andreas Zietzer ◽

Julian Wiora ◽

...

Keyword(s):

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

High Volume ◽

Lower Mortality ◽

Circulatory Support ◽

Syntax Score ◽

Urgent Revascularisation ◽

Complete Revascularisation ◽

Residual Syntax Score ◽

Trial Evidence

Background: Acute myocardial infarction-related cardiogenic shock (AMI-CS) still has high likelihood of in-hospital mortality. The only trial evidence currently available for the intra-aortic balloon pump showed no benefit of its routine use in AMI-CS. While a potential benefit of complete revascularisation has been suggested in urgent revascularisation, the CULPRIT-SHOCK trial demonstrated no benefit of multivessel compared to culprit-lesion only revascularisation in AMI-CS. However, mechanical circulatory support was only used in a minority of patients.Objectives: We hypothesised that more complete revascularisation facilitated by Impella support is related to lower mortality in AMI-CS patients.Methods: We analysed data from 202 consecutive Impella-treated AMI-CS patients at four European high-volume shock centres (age 66 ± 11 years, 83% male). Forty-seven percentage (n = 94) had cardiac arrest before Impella implantation. Revascularisation was categorised as incomplete if residual SYNTAX-score (rS) was >8.Results: Overall 30-day mortality was 47%. Mortality was higher when Impella was implanted post-PCI (Impella-post-PCI: 57%, Impella-pre-PCI: 38%, p = 0.0053) and if revascularisation was incomplete (rS ≤ 8: 37%, rS > 8: 56%, p = 0.0099). Patients with both pre-PCI Impella implantation and complete revascularisation had significantly lower mortality (33%) than those with incomplete revascularisation and implantation post PCI (72%, p < 0.001).Conclusions: Our retrospective analysis suggests that complete revascularisation supported by an Impella microaxial pump implanted prior to PCI is associated with lower mortality than incomplete revascularisation in patients with AMI-CS.

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