Comparison of SYNTAX score II efficacy with SYNTAX score and TIMI risk score for predicting in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction

  • Yavuz Karabağ
  • Metin Çağdaş
  • Ibrahim Rencuzogullari
  • Süleyman Karakoyun
  • İnanç Artaç
  • Doğan İliş
  • Mahmut Yesin
  • Mesut Öterkus
  • Tayyar Gokdeniz
  • Cengiz Burak
  • Ibrahim Halil Tanboğa
Original Paper


SYNTAX score II (SS-II) has a powerful prognostic accuracy in patients with stable complex coronary artery disease who have undergone revascularization; however, there is limited data regarding the prognosis of patients with ST segment elevation myocardial infarction (STEMI). The aim of this study is to examine both the predictive performance of SS-II in determining in-hospital and long term mortality of STEMI patients and to compare SYNTAX score (SS) and TIMI risk score (TRS). Consecutive 1912 STEMI patients treated with primary percutaneous coronary intervention (p-PCI) retrospectively reviewed, and the remaining 1708 patients constituted the study population after exclusion. The patients were divided into three groups according to increased SS-II value: low (n:562; SS-II ≤ 24.6); intermediate (n:563; 24.6 < SS-II < 34.4); and high tertile (n:583; SS-II ≥ 34.4). In-hospital and long term mortality rate from all causes (0 vs. 0.5 vs. 10.6% and 1.8 vs. 3.2 vs. 18.1% respectively, p ≤ 0.001) were significantly increased with SS-II tertiles and SS-II was found to be independent predictor of in-hospital and long term mortality (HR: 1.076 95% CI 1.060–1.092, p < 0.001) and (HR: 1.070 95% CI 1.050–1.090, p < 0.0001). The predictive power of SS-II, SS, and TRS were compared by ROC curve and decision curve analysis. SS-II surpassed SS and TRS in long-term and in-hospital mortality prediction. SS-II is a powerful tool to predict in-hospital and long-term mortality from all causes in STEMI patients treated with p-PCI.


SYNTAX score II SYNTAX score TIMI risk In-hospital and long-term mortality ST segment elevation myocardial infarction Primary percutaneous coronary intervention 



The authors thank for their contributions to statistical analysis and trial design.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Steg PG et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33:2569–2619CrossRefPubMedGoogle Scholar
  2. 2.
    Sidney S et al (2013) The “heart disease and stroke statistics–2013 update” and the need for a national cardiovascular surveillance system. Circulation 127(1):21–23CrossRefPubMedGoogle Scholar
  3. 3.
    Magro M et al (2011) Value of the SYNTAX score in patients treated by primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: the MI SYNTAXscore study. Am Heart J 161(4):771–781CrossRefPubMedGoogle Scholar
  4. 4.
    Morrow DA et al (2000) TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation. Circulation 102(17):2031–2037CrossRefPubMedGoogle Scholar
  5. 5.
    Endo A et al (2015) Angiographic lesion complexity score and in-hospital outcomes after percutaneous coronary intervention. PLoS ONE 10(6):e0127217CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Yang CH et al (2013) The prognostic significance of SYNTAX score after early percutaneous transluminal coronary angioplasty for acute ST elevation myocardial infarction. Heart Lung Circ 22(5):341–345CrossRefPubMedGoogle Scholar
  7. 7.
    Yang CH et al (2012) SYNTAX score: an independent predictor of long-term cardiac mortality in patients with acute ST-elevation myocardial infarction. Coron Artery Dis 23(7):445–449CrossRefPubMedGoogle Scholar
  8. 8.
    Ong AT et al (2006) The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: design, rationale, and run-in phase. Am Heart J 151(6):1194–1204CrossRefPubMedGoogle Scholar
  9. 9.
    Popovic B et al (2016) Prognostic value of the thrombolysis in myocardial infarction risk score in ST-elevation myocardial infarction patients with left ventricular dysfunction (from the EPHESUS Trial). Am J Cardiol 118(10):1442–1447CrossRefPubMedGoogle Scholar
  10. 10.
    Rivera-Fernandez R et al (2016) Prolonged QT interval in ST-elevation myocardial infarction and mortality: new prognostic scale with QT, Killip and age. J Cardiovasc Med 17(1):11–19CrossRefGoogle Scholar
  11. 11.
    Freisinger E, Malyar NM, Reinecke H (2016) Peripheral artery disease is associated with high in-hospital mortality particularly in males with acute myocardial infarction in a nationwide real-world setting. Vasa 45(2):169–174CrossRefPubMedGoogle Scholar
  12. 12.
    Polikutina OM et al (2015) Impact of chronic obstructive pulmonary disease on one-year prognosis in patients with ST-segment elevation myocardial infarction. Ter Arkh 87(9):52–57CrossRefPubMedGoogle Scholar
  13. 13.
    Lang R et al (2005) American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463CrossRefPubMedGoogle Scholar
  14. 14.
    Satogami K et al (2017) Impact of plaque Rupture detected by optical coherence tomography on transmural extent of infarction after successful stenting in ST-segment elevation acute myocardial infarction. JACC Cardiovasc Interv 10(10):1025–1033CrossRefPubMedGoogle Scholar
  15. 15.
    Sianos G et al (2005) The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 1(2):219–227PubMedGoogle Scholar
  16. 16.
    Farooq V et al (2013) Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet 381(9867):639–650CrossRefPubMedGoogle Scholar
  17. 17.
    Sianos G, Papafaklis MI, Serruys PW (2010) Angiographic thrombus burden classification in patients with ST-segment elevation myocardial infarction treated with percutaneous coronary intervention. J Invasive Cardiol 22:6B–14BPubMedGoogle Scholar
  18. 18.
    Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E (1996) TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 93:879–888CrossRefPubMedGoogle Scholar
  19. 19.
    Overgaard CB et al (2013) Percutaneous revascularization and long term clinical outcomes of diabetic patients randomized in the Occluded Artery Trial (OAT). Int J Cardiol 168(3):2416–2422CrossRefPubMedGoogle Scholar
  20. 20.
    Steyerberg EW, Vickers AJ (2008) Decision curve analysis: a discussion. Med Decis Making 28(1):146–149CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Wang G et al (2016) Usefulness of the SYNTAX score II to predict 1-year outcome in patients with primary percutaneous coronary intervention. Coron Artery Dis 27:483–489CrossRefPubMedGoogle Scholar
  22. 22.
    Farooq V et al (2013) Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention: validation of the logistic clinical SYNTAX (Synergy between Percutaneous Coronary Interventions with Taxus and Cardiac Surgery) score. JACC Cardiovasc Interv 6(7):737–745CrossRefPubMedGoogle Scholar
  23. 23.
    Scherff F et al (2011) The SYNTAX score predicts early mortality risk in the elderly with acute coronary syndrome having primary PCI. J Invasive Cardiol 23(12):505–510PubMedGoogle Scholar
  24. 24.
    Campos CM, Garcia-Garcia HM, van Klaveren D, Ishibashi Y, Cho YK, Valgimigli M et al (2015) Validity of SYNTAX score II for risk stratification of percutaneous coronary interventions: a patient-level pooled analysis of 5433 patients enrolled in contemporary coronary stent trials. Int J Cardiol 187:111–115CrossRefPubMedGoogle Scholar
  25. 25.
    Palmerini T et al (2011) Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. J Am Coll Cardiol 57(24):2389–2397CrossRefPubMedGoogle Scholar
  26. 26.
    Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, Giugliano RP, McCabe CH, Braunwald E (2000) TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 102:2031–2037CrossRefPubMedGoogle Scholar
  27. 27.
    Morrow DA, Antman EM, Parsons L, de Lemos JA, Cannon CP, Giugliano RP, McCabe CH, Barron HV, Braunwald E (2001) Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. JAMA 286:1356–1359CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Yavuz Karabağ
    • 1
  • Metin Çağdaş
    • 1
  • Ibrahim Rencuzogullari
    • 1
  • Süleyman Karakoyun
    • 1
  • İnanç Artaç
    • 1
  • Doğan İliş
    • 1
  • Mahmut Yesin
    • 2
  • Mesut Öterkus
    • 3
  • Tayyar Gokdeniz
    • 4
  • Cengiz Burak
    • 5
  • Ibrahim Halil Tanboğa
    • 6
  1. 1.Department of CardiologyKafkas UniversityKarsTurkey
  2. 2.Department of CardiologyKars Harakani State HospitalKarsTurkey
  3. 3.Department of Anesthesia and ReanimationKafkas UniversityKarsTurkey
  4. 4.Department of CardiologyMedipol UniversityIstanbulTurkey
  5. 5.Department of CardiologyMidyat State HospitalMardinTurkey
  6. 6.Department of CardiologyAtaturk UniversityErzurumTurkey

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