Correlation of clinical cardiac risk scores, grace and timi with angiographic syntax score in stemi

Background: Cardiovascular diseases have emerged as a significant health burden and became a leading cause of mortality in developing countries like India. In cardiovascular diseases, acute coronary syndromes (ACS) are the primary cause of morbidity and mortality. Patients with ST-elevation myocardial infarction (STEMI) are a heterogeneous group, with a prognosis that ranges from one with an excellent outcome with modest adjustments in therapeutic regimen to one in which the risk of death or recurrent complications are high, requiring intensive treatment. Accordingly, risk stratification plays a central role in the evaluation and management of patients with STEMI. Different scoring systems are available based on initial clinical history, electrocardiographic and laboratory tests that enable early risk stratification on admission. The risk scores were created and recommended by national and international guidelines to identify patients with a higher probability of adverse events, recommending more intensive treatment and early angiography in this population. Angiography predicts Major Adverse Cardiovascular Events (MACE) in STEMI and helps in deciding revascularization. Clinical predictors like duration of chest pain, age, cardiac biomarker positivity, ST-segment changes in electrocardiogram (ECG), Congestive Heart Failure (CHF) help in predicting the high-risk group. Similarly, clinical risk scores like TIMI (Thrombolysis in Myocardial Infarction) score, and GRACE (Global Registry of Acute Coronary Events) scores have established a role in risk stratification and predicting the prognosis. The SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and cardiac Surgery) score is an anatomical-based risk score that considers features such as thrombus, bifurcations, calcifications, total occlusions, and diffuse disease. This study aim to assess correlation of clinical cardiac scores, GRACE and TIMI with angiographic SYNTAX score in STEMI patients.
Methodology: Single-center, prospective study conducted in the Department of Cardiology, King George Hospital, and Visakhapatnam. The study included 251 patients presented to the department of cardiology, KGH, between January 2020 and December 2021 with a diagnosis of STEMI and who underwent Coronary angiography. TIMI, GRACE scores were calculated based on history, vital parameters, lab investigations & ECG. All patients underwent diagnostic Coronary Angiography (CAG). Using SYNTAX score angiographic assessment of lesion severity was done. The percentage of stenosis and length of the lesion was calculated by using quantitative coronary angiography software. Inferential and descriptive statistical analysis has been carried out in the current study. Results on continuous variables are presented as Mean ± SD (Min-Max), and results on categorical variables are expressed as frequency and percentages (%). Correlation analysis with Pearson’s coefficient was done to establish the correlation between risk scores. Multivariate linear regression analysis was done to know the association between clinical predictors and angiographic scores.
Results: Out of 251 patients in our study population, 186 (74.1%) were males and 65 (25.9%) were female. The patient’s ages ranged from 23 to 85 years. 53.6±10.6 years were the mean age of the patients, with the majority of the patients were in the age group of 51-60 years and females having a slightly higher age at presentation. In our study population, anterior wall STEMI and anterolateral STEMI constitute most cases, 102 (40.6%), 54 (21.5 %) respectively. Among the study population, 24(9.5%) patients had low TIMI score, 172 (68.5%) had intermediate TIMI score, and 55(22%) had high TIMI score at presentation with a mean TIMI score of 5.1±2.2. Among the study population, 30(11.9%) had a low GRACE score, 73 (29%) had intermediate GRACE score, 148(59%) had high GRACE Score with a mean GRACE SCORE of 152.2±37. All patients in the study group underwent CAG, angiographic score SYNTAX SCORE was calculated, and were stratified into low (≤22), Intermediate (23-32), High (>32).Among the study population, 215(85.6%) had low syntax score, 26 (10%) had intermediate syntax score, and 10 (4%) had a high syntax score with an average SYNTAX score of 11.8±8.7.
Conclusion: Our study confirmed that there was a significant correlation between TIMI and SYNTAX scores (p-value 0.10), between GRACE and SYNTAX scores (p-value<0.001), our study confirmed the correlation between higher clinical risk scores with the severity of coronary artery disease assessed by Syntax scores. The higher scores in TIMI and GRACE scoring systems had a significantly greater angiographic disease when compared to low scores. GRACE risk score had a more significant correlation with Syntax score