O Syntax Score como ferramenta de predição de eventos adversos em pacientes submetido à estratégia fármaco-invasiva no infarto agudo do miocárdio

• Ano de defesa: 2019
• Autor(a) principal: Cintra, Guilherme Fernandes [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/00130000219hm
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Cardiology; Acute Myocardial Infarction; Thrombolytic Therapy; Percutaneous Coronary Intervention; Cardiologia; Infarto Do Miocárdio; Terapia Trombolítica; Angioplastia
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7741510; https://repositorio.unifesp.br/handle/11600/59450

Syntax Score (SS) is an excellent tool for assessing the anatomical severity of coronary disease and is a good predictor of post-treatment adverse events in stable patients as well as in acute coronary syndrome. However, there are no data in the literature about SS to assess the in-hospital prognosis of patients with ST-segment elevation myocardial infarction submitted to the pharmacoinvasive strategy as treatment. Objective: This study provides a retrospective analysis of the SS and residual Syntax Score (SSr), as well as other angiographic and clinical data of patients submitted to Pharmacoinvasive Strategy (PIS) through the STEMI protocol in the city of São Paulo with UNIFESP / HSP and to develop a new tool for adverse event prediction. Methods: Correlation of clinical data with anatomic and functional angiographic evaluation before and after angioplasty to evaluate the prognostic accuracy related to intrahospital mortality. A total of 679 consecutive patients were selected through this protocol, 530 of whom met the inclusion criteria (fibrinolysis prior to angioplasty and without previous history of coronary artery bypass graft). Results: Overall in-hospital mortality was 5.3%. The average Syntax Score was 11.8. However, when we associate the functional variables related to the culprit artery flow (TIMI Flow Initial/Final), we obtain a new and accurate prognostic tool for this population - the Syntax-Flow Score. Syntax-Flow Score demonstrates superior calibration and performance in the ROC curve and, when > 22, demonstrates superior statistical performance to predict adverse events in patients submitted to PIS (p <0.01), when compared with SS ≥ 15 (p = 0.11) or residual SS ≥ 7 (p = 0.04) analyzed alone. Conclusion: Due to a better accuracy compared to other prognostic scores, the Syntax-Flow score is a prognostic tool with superior performance for in-hospital mortality in patients undergoing PIS.