Assessment of Predictive Value of SYNTAX-II Score for Adverse Cardiac Events and Clinical Outcomes in Patients With Acute Coronary Syndrome.

Prognostic information is important for the management of acute coronary syndrome (ACS). Our aim was to evaluate Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score-II (SSII) for predicting contrast induced nephropathy (CIN) and one-year major adverse cardiac events (MACE) in ACS patients. Coronary angiographic recordings of 1304 ACS patients were retrospectively examined. Predictive values of SYNTAX score (SS), SSII-percutaneous coronary intervention (SSII-PCI), SSII-coronary artery bypass graft (SSII-CABG) scores for CIN and MACE were assessed. Combination of CIN and MACE ratios constituted primary composite end-point. Patients with SSII-PCI scores >32.55 were compared with patients with lower scores. All of the three scoring systems predicted the composite primary end-point [SS: Area under the curve (AUC): .718, P < .001 (95% CI: .689-.747), SSII-PCI: AUC: .824, P < .001 (95% CI: .800-.849), SSII-CABG: AUC: .778, P < .001 (95% CI: .751-.805)]. Comparison of AUC of receiver operating characteristic curves showed that SSII-PCI score had better predictive value than that of SS and SSII-CABG scores. In multivariate analysis, the only predictor of the primary composite end-point was SSII-PCI score (odds ratio: 1.126, 95% CI: 1.107-1.146, P < .001). SSII-PCI score was a valuable tool for prediction of shock, CABG, myocardial infarction, stent thrombosis, development of CIN and one-year mortality.

Assessment of Systemic Immune-Inflammation Index and Systemic Inflammation-Response Index in Different Coronary Artery Plaque Types.

Coronary computed tomography angiography can evaluate coronary arterial plaque composition with high resolution. We aimed to determine and compare the values of systemic immune-inflammation index (SII) and systemic inflammation-response index (SIRI) in different plaque types. Highest values of SIRI and SII were found in mixed plaque type followed by non-calcified plaque type. SII value of 463.07 predicted one-year major adverse cardiac events (MACE) with a sensitivity of 72.7% and specificity of 64.3% and SIRI value of 1.14 predicted one-year MACE with a sensitivity of 93% and specificity of 62%. Paired analysis of area under the curve (AUC) of the receiver operating characteristic curves showed that SIRI had higher AUC than coronary calcium score and SII. Univariate logistic regression results showed that age, creatinine level, coronary calcium score, SII, and SIRI were the independent predictors of one-year MACE. According to the results of multivariate regression analysis, after adjusting other factors, age, creatinine level, and SIRI were the independent predictors of one-year MACE. SIRI seemed to improve the risk prediction in coronary artery disease. Therefore, special attention may need to be paid to patients who have a high SIRI.

A Novel Risk Assessment Model Using Urinary System Contrast Blush Grading to Predict Contrast-Induced Acute Kidney Injury in Low-Risk Profile Patients.

Contrast-induced acute kidney injury (CI-AKI) can occur after coronary interventions despite protective measures. We evaluated the effect of urinary system contrast blush grading for predicting post-procedure CI-AKI in 486 patients with chronic coronary artery disease. Patient characteristics and blood samples were collected. Urinary system contrast blush grade was recorded during the coronary angiography and interventions. Post-procedure third to fourth day blood samples were collected for diagnosis of CI-AKI. The median age of the patients was 61 years (53-70, interquartile range), and 194 (39.9%) participants were female. Contrast-induced acute kidney injury occurred in 78 (16%) patients. By comparing full and reduced models with the likelihood ratio test, it was observed that in the reduced model, factors such as age, diabetes mellitus, body weight-adapted contrast media (CM), hemoglobin, and urinary system blush were associated with CI-AKI presence. The probability of CI-AKI presence increased slightly from grade 0 to 1 blush, but it increased sharply grade from 1 to 2 blush. According to our results, an increase in body weight-adapted CM and urinary blush grading were the main predictors of CI-AKI. These findings suggest that when body weight-adapted CM ratio exceeds 3.5 mL/kg and urinary contrast blush reaches grade 2, the patients should be followed up more carefully for the development of CI-AKI.