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Correlation between NSTE-ACS risk scores with Syntax: can we predict coronary lesion complexity before angiography?
Session:
Comunicações Orais (Sessão 18) - Doença Coronária e Cuidados Intensivos 4 - Risco e Prognóstico
Speaker:
Sérgio Maltês
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sérgio Maltês; Mariana Paiva; Gustavo sá Mendes; Sérgio Madeira; Rui Campante Teles; Manuel Almeida; Jorge Ferreira; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Background and aim</span></u><span style="color:black">: Standard single antiplatelet regimen (SAPT) is currently recommended before invasive risk stratification in non-ST elevation acute coronary syndromes (NSTE-ACS). However, there are subsets in whom dual antiplatelet therapy (DAPT) may be more protective according to the coronary anatomy and revascularization strategy. We aimed to identify pre-procedural predictors of coronary artery complexity that may be helpful in selecting an individualized antiplatelet regimen.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Methodology</span></u><span style="color:black">: Retrospective single-center study including patients with NSTE-ACS performing coronary angiography between January 2020 and July 2021. Clinical variables and classic NSTE-ACS risk scores (TIMI, GRACE and HEART) were captured and SYNTAX 1 score was calculated. Patients were divided into low (0-22), moderate (23-32) and high (≥33) SYNTAX score. Multivariate logistic regression analysis was performed to determine predictors of anatomical complexity (defined as significant left main disease [stenosis ≥50%] or SYNTAX ≥33).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Results</span></u><span style="color:black">: A total of 448 patients were included (mean age 67 ± 13 years; 74% males; 85% with NSTE-myocardial infarction). Overall, 350 (78%), 63 (14%) and 35 (8%) patients had a low, moderate or high-SYNTAX score, respectively. Thirty-one (7%) patients had significant left main </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">disease. At multivariate analysis (adjusted for age, diabetes, renal function, GRACE and TIMI scores), the HEART score (odds ratio 2.3, 95% confidence interval 1.5-3.3, p<0.001) predicted a high coronary anatomical complexity. When performing ROC curve analysis, the HEART score had a significant discriminative ability in identifying those with complex coronary anatomy (area under the curve 0.79, 95% CI 0.72-0.86, p<0.001) (<strong>figure 1</strong>) – a score >7 showed a sensitivity of 76% and specificity of 75% in identifying such patients.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Conclusion</span></u><span style="color:black">: </span></span></span></span><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">In this cohort of NSTE-ACS patients, the HEART score was an independent predictors of complex coronary anatomies. These results suggest that those with high (>7) HEART score benefit from SAPT as opposed to DAPT, given the high probability of complex lesions amenable to CABG. </span></span></span></span></p>
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