SPC365

SAMY Score: A Discriminative Tool for Distinguishing Myocarditis from Acute Coronary Syndrome

Session: Sessão de Posters 11 - Miocardite Aguda
Speaker: Mariana Isabel Duarte Almeida

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 17. Myocardial Disease
Subtheme: 17.4 Myocardial Disease – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Mariana Duarte Almeida; João Gouveia Fiuza; Gonçalo Ferreira; Vanda Devesa Neto; Luísa Gonçalves; Nuno Craveiro
<p style="text-align:justify"><strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">Background:</span></strong><span style="color:#000000; font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif; font-size:medium"> Distinguishing between myocarditis and acute coronary syndrome (ACS) poses challenges due to overlapping symptoms of chest pain and troponin elevation. The European Society of Cardiology recommends excluding coronary disease (greater or equal to 5</span><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">0% stenosis) in suspected myocarditis, but invasive angiography has a 1-2% complication risk. Cardiac magnetic resonance imaging (CMR) is a safer alternative, indicating myocarditis, and ruling out&nbsp;myocardial infarction. In the absence of accessible CMR, SAMY score, validated for myocarditis vs. ACS, aids physicians in decision-making. It considers age, C-reactive protein, leukocyte count, recent infection (&lt;4 weeks), hypertension, and hyperlipidemia. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">Methods:</span></strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif"> Retrospective data from June 2021 to May 2023 were collected for chest pain admissions in a Cardiac Intensive Care Unit with elevated troponin levels suggestive of myocardial infarction and absence of significant coronary artery obstruction (MINOCA-diagnosed patients). Demographics, blood labs, CMR details and discharge diagnosis were gathered</span><span style="font-size:11pt"><span style="font-family:TimesNewRomanPSMT,serif">. </span></span><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">SAMY score was calculated for each patient and compared with CMR diagnosis. Independent t-test was used for SAMY score comparison between groups. Logistic regression was used to assess the association between PERFORM and outcomes. The score&rsquo;s capacity to predict myocarditis diagnosis was analyzed using ROC curve and respective area under the curve (AUC).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">Results:</span></strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif"> A cohort of 58 patients, 67.2% being females, was analyzed. The mean age was 65.8 </span><span style="font-family:Symbol">&plusmn;</span>&nbsp;<span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">15.9 years old. Of these patients, 56.9% underwent CMR (n=33), which suggested a myocarditis diagnosis in 54.5% (n=18) of the cases. Patients with a CMR-diagnosis of myocarditis had a higher SAMY score (3.5 </span><span style="font-family:Symbol">&plusmn;</span><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif"> 2.7), compared&nbsp;with those without myocarditis (1.4 </span><span style="font-family:Symbol">&plusmn;</span><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif"> 2.7), with a statistically significant difference between the groups (p=0.032). This suggests that SAMY score can predict myocarditis diagnosis, yielding an odds ratio of 1.358 (p=0.042; 95% CI: 1.011-1.824). Receiver Operating Characteristic (ROC) analysis was conducted, resulting in an Area Under the Curve (AUC) value of 0.724 (p=0.029; 95% CI: 0.540-0.909), meaning a moderate discriminatory capacity.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif">Conclusions:</span></strong><span style="font-family:&quot;Abadi MT Condensed Light&quot;,sans-serif"> The SAMY score is a practical tool in the emergency department, using six easily obtainable clinical variables for myocarditis and ACS differentiation. However, low SAMY score does not conclusively negate myocarditis, nor does a higher score definitively establish the diagnosis. Attending physicians should integrate clinical data, considering the SAMY score, while assessing risks and benefits associated with potential percutaneous coronary intervention for each patient. Future refinements in scoring systems hold the promise of tailoring invasive angiography interventions to those individuals who stand to derive the most benefit. </span></span></span></span></p>