Correlation between NSTE-ACS risk scores with Syntax: can we predict coronary lesion complexity before angiography?

Abstract Background and aim Standard single antiplatelet regimen (SAPT) is currently recommended before invasive risk stratification in non-ST elevation acute coronary syndromes (NSTE-ACS). However, there are subsets whom dual therapy (DAPT) may be more protective according to the anatomy revascularization strategy. We aimed identify pre-procedural predictors of artery complexity that helpful selecting an individualized regimen. Methodology Retrospective single-center study including patients with NSTE-ACS performing angiography between January 2020 July 2021. Clinical variables classical scores (TIMI, GRACE HEART) were captured SYNTAX 1 score was calculated. Patients divided into low (0–22), moderate (23–32) high (≥33) score. Multivariate logistic regression analysis performed determine anatomical (defined as significant left main disease [stenosis ≥50%] or ≥33). Results A total 448 included (mean age 67±13 years; 74% males; 85% NSTE-myocardial infarction). Overall, 350 (78%), 63 (14%) 35 (8%) had a low, high-SYNTAX score, respectively. Thirty-one (7%) disease. At multivariate (adjusted for age, diabetes, renal function, TIMI scores), HEART (hazard ratio 2.3, 95% confidence interval 1.5–3.3, p<0.001) predicted complexity. When ROC curve analysis, discriminative ability identifying those complex (area under 0.79, CI 0.72–0.86, (Figure 1) – >7 showed sensitivity 76% specificity 75% such patients. Conclusion In this cohort patients, independent anatomies. These results suggest (>7) merit from SAPT opposed DAPT, given probability lesions amenable CABG. Funding Acknowledgement Type funding sources: None.