Value of syntax score II for predicting in-hospital and long-term survival in octogenarians with ST-segment elevation myocardial infarction: A comparison of six different risk scores
Introduction
Deaths from ischemic heart diseases have decreased in recent years due to an increase in percutaneous coronary intervention (PCI), modern antithrombotic therapy as well as secondary prevention (Hartley et al., 2016; Puymirat et al., 2012). Nevertheless, the mortality of unselected patients with ST-segment elevation myocardial infarction (STEMI) remains high (Ibanez et al., 2018). Primary PCI (pPCI) remains the treatment of choice for STEMI, and there is no identified upper age limit with respect to reperfusion, especially for pPCI (Bueno et al., 2011).
The current guidelines strongly recommend that all patients with STEMI should be assessed in terms of short- and long-term risks because of subsequent adverse events, such as heart failure, recurrent ischemia, residual ischemia, mechanical complications, and death (Ibanez et al., 2018). To date, various scoring systems and scales have been used to predict the prognosis in STEMI patients. These scoring systems include the Primary angioplasty in myocardial infarction (PAMI) risk score (Addala et al., 2004), Thrombolysis in Myocardial Infarction (TIMI) risk score, Global registry of acute coronary events (GRACE), Zwolle, Controlled abciximab and device investigation to lower late angioplasty complications (CADILLAC) (Kozieradzka et al., 2011), Syntax Score (SS) (Magro et al., 2011b), Clinical Syntax Score (Cetinkal et al., 2016), and Syntax Score II (SSII) (Wang et al., 2016). However, the majority of these scores are designed for the general population, and their predictive power for octogenarians has not been sufficiently elucidated.
The life expectancy of the population has increased and the ratio of octogenarians in the general population is expected to increase threefold by 2050 due to improvements in health care (Centers for Disease Control & Prevention, 2003). Therefore, it is expected to encounter more elderly STEMI patients. Although the gold standard treatment of STEMI is pPCI, it may not result in an improved survival in elderly STEMI patients, unlike younger patients with STEMI (Claessen et al., 2010; Oduncu et al., 2013; Yamanaka et al., 2013). Many factors have been put forward to explain the inability of pPCI to achieve desired outcomes in the elderly. These include the presence of atypical symptoms, which result in delayed admission to the hospital (Brieger et al., 2004), in addition to an increased risk of bleeding, a reduction in the organ functions, and the presence of comorbidities (Alexander et al., 2005; Malkin, Prakash, & Chew, 2012). Considering the worse prognosis of elderly STEMI patients, an identifying the most suitable risk scoring system is crucial. This study evaluated the usefulness of SSII in predicting in-hospital and long-term (3.5 years) outcomes in octogenarians who presented with STEMI and were treated with pPCI in addition to compare the SSII with other well-known risk-scoring systems.
Section snippets
Study population
A total of 325 consecutive STEMI octogenarians, who underwent pPCI between January 2010 and June 2016, at Kafkas University and Ataturk University, Turkey, were retrospectively enrolled in the study. STEMI was defined based on the following criteria: I-) a typical increase or decrease in cardiac biomarkers, II-) ongoing ischemic symptoms (within 12 h of presentation), III-) a newly developed left bundle-branch block pattern, or a new ST elevation in two or more contiguous leads, with readings
Results
The study population consisted of 312 STEMI patients (mean age: 85 ± 4.5 years; 47.5% female) who underwent pPCI. The SSII of the patients ranged from 22 to 80 (median 43.6). The patients were divided into two groups according to median SSII values: a low SSII group (SSII ≤ 43.6, n = 163 patients) and a high SSII group (SSII > 43.6, n = 149). Baseline characteristics of all the patients and those with a low and high SSII are shown in Table 1. Patients in a high SSII group were older, and female
Discussion
In this study, the association of SSII with in-hospital and long-term mortality was evaluated in octogenarians who presented with STEMI and were treated with pPCI. The main finding of this study was that SSII was an independent predictor of both in-hospital and long-term mortality in octogenarians. When compared to the other risk scoring systems, SSII and CADILLAC were superior to other well-known risk scores but not superior to each other.
Octogenarians constitute a fast-growing portion of
Conclusions
To the best of our knowledge, this study is the first in the literature to show that SSII is an independent predictor of in-hospital and long-term mortality in octogenarians who presented with STEMI and treated with pPCI. In this study, SS II and CADILLAC were superior compared to the other risk scoring systems in terms of predicting mortality. The prognostic value of SS II may be due to the inclusion of some clinical parameters, all of which are common in the elderly and have been related with
Compliance with ethical standards
All authors declare that they do not have conflicts of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was not needed because the study had a retrospective design.
Declaration of conflicting interests
The authors declare they have no conflicts of interest.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
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