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Residual SYNTAX Score in Relation to Coronary Culprit Plaque Characteristics and Cardiovascular Risk in ST Segment Elevation Myocardial Infarction: an Intravascular Optical Coherence Tomography Study


This study aimed to investigate the association of high-risk culprit plaque features by optical coherence tomography (OCT) with residual SYNTAX score (rSS) and the predictive value of rSS for major adverse cardiac events (MACE) in patients with ST segment elevation myocardial infarction (STEMI). We included 274 patients and divided them into 3 groups — rSS=0 (n=72), 0<rSS≤8 (n=134), and rSS>8 (n=68). There were significant differences in plaque characteristics among three groups (plaque rupture: 44.4% versus 59.0% versus 64.7%, lowest to highest rSS, p=0.040; OCT-defined high-risk plaques: 16.7% versus 23.9% versus 35.3%, lowest to highest rSS, p=0.036; calcification: 38.9% versus 52.5% versus 61.8%, lowest to highest rSS, p=0.024). During a mean follow-up of 2.2 years, MACE occurred in 47 (17.2%) patients; rSS >8 group had higher MACE risk compared to rSS=0 (HR: 2.68, 95%CI: 1.11–6.5, P=0.029). In conclusion, culprit plaque morphology was significantly correlated with rSS, and elevated rSS was associated with higher cardiovascular risk in STEMI patients. NCT03593928

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We gratefully acknowledge all individuals who participated in this study. We are grateful to the Department of Cardiology, Cardiovascular Institute of Fuwai Hospital, for its help in recruiting patients.


This study is supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2016-I2M-1-009), National Natural Science Foundation of China (81970308), Shenzhen Key Medical Discipline Construction Fund (SZXK001) and the Fund of “Sanming” Project of Medicine in Shenzhen (SZSM201911017).

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Corresponding author

Correspondence to Hongbing Yan.

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Human Subjects/Informed Consent Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. The study was approved by the institutional ethics committee of Fuwai Hospital (No. 2017-866), and informed consent was obtained from all patients being included in the study.

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The authors declare no competing interests.

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Associate Editor Craig M. Stolen oversaw the review of this article

Supplementary Information

Supplementary Fig.1 Representative cross-sectional optical coherence tomography images. a Fibrous plaque identified as a homogeneous, highly backscattering region (asterisk). b Lipid-rich plaque identified as a low-signal region with a diffuse border (asterisk) and thin-cap fibroatheroma with fibrous cap thickness of 50 μm. c Plaque rupture identified by the discontinuous fibrous cap (arrow) and cavity formation (asterisk). d Plaque erosion identified by the presence of attached thrombus (arrow) overlying an intact plaque. e Calcification identified by the presence of a well-delineated, low-backscattering heterogeneous region (asterisk). f Micro-vessels recognized as low-signal, sharply delineated, tubule luminal structures (arrow). g Cholesterol crystal (arrow) identified by linear, highly backscattering structures without remarkable backward shadowing. h Macrophage infiltration (arrow) defined as a signal-rich, highly reflective, punctate region with backward shadowing. (Adapted from reference[10] with permission).

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Wang, Y., Zhao, X., Zhou, P. et al. Residual SYNTAX Score in Relation to Coronary Culprit Plaque Characteristics and Cardiovascular Risk in ST Segment Elevation Myocardial Infarction: an Intravascular Optical Coherence Tomography Study. J. of Cardiovasc. Trans. Res. (2021).

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  • Residual SYNTAX score
  • Plaque rupture
  • Cardiovascular risk
  • ST segment elevation myocardial infarction