Prognostic Impact of SYNTAX and SYNTAX II Scores in Patients with Acute Myocardial Infarction

Acute myocardial infarction (AMI) continues to be a clinically significant condition due to its association with morbidity and mortality after the initial event. Therefore, the prognostic stratification of these patients is of vital importance.

Impacto pronóstico del score SYNTAX y score SYNTAX II en pacientes con IAM

One of the tools that have been used for several years for this purpose is the SYNTAX I (SS) and SYNTAX II (SS-II) scores, which are highly useful when deciding between percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) surgery. However, the role of these scores in AMI patients undergoing PCI has been seldom investigated.The aim of this retrospective, observational study was to assess the long-term prognosis of a cohort of AMI patients who underwent PCI.The primary endpoint (PEP) was defined as the all-cause mortality rate, while the secondary endpoint (SEP) included cardiovascular mortality and recurrent AMI rates.A total of 915 patients were included in the analysis, and the average follow-up time was 1,137 days. The average patient age was 62 years, and most subjects were men. The most common clinical presentation type was ST-segment elevation myocardial infarction (STEMI), accounting for 77% of cases. The most frequently treated coronary artery was the left anterior descending artery (63%), followed by the right coronary artery (50%), the circumflex artery (29%), and the left main coronary artery (3%). Multivessel disease was reported in 39% of the patients.

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Regarding the results, the PEP was observed in 11.7% of the patients, while the cardiovascular mortality and recurrent AMI rates were 8% and 9.8%, respectively. After a Cox regression analysis adjusted for propensity score weighting, it was found that the SS-II was significantly associated with the risk of all-cause mortality (hazard ratio [HR], 1.08; confidence interval [CI], 1.06−1.10; p <0.001), cardiovascular death (HR, 1.08; CI, 1.06−1.10; p <0.001), and recurrent AMI (HR, 1.03; CI, 1.01−1.05; p <0.001). The SS also showed a significant association with the risk of all-cause mortality (HR, 1.02; CI, 1.00−1.04; p = 0.017) and cardiovascular death (HR, 1.04; CI, 1.01−1.06; p < 0.001), but no association with recurrent AMI (HR, 1.01; CI, 0.99−1.03; p = 0.297).At 5 years, a receiver-operating characteristic (ROC) analysis demonstrated that the SS-II had significantly better ability to predict all-cause mortality compared with the SS (area under the curve [AUC], 0.82 vs. 0.64; p <0.001).


In conclusion, in this real-world cohort of AMI patients treated with PCI, the SS-II performed better than SS in stratifying the long-term mortality risk. Furthermore, the SS-II, and not the SS, emerged as an independent predictor of recurrent AMI. These findings underscore the importance of integrating clinical and anatomical characteristics in the prognostic stratification of these patients.

Dr. Andrés Rodríguez.
Member of the Editorial Board of

Original Title: Prognostic significance of the SYNTAX score and SYNTAX score II in patients with myocardial infarction treated with percutaneous coronary intervention.

Reference: Marco Di Maio MD et al Catheter Cardiovasc Interv. 2023;1–9.

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