Utility of Residual Syntax Score to Predict Outcome After Acute Myocardial Infarction
Condition: Myocardial Infarction
MeSH terms: Myocardial Infarction; Infarction
Study type: Observational

Summary: 
      The aim of this study is to evaluate the utility of residual syntax score after PCI of the
      culprit vessel for patients with AMI (STEMI or NSTEMI) to predict 6-months clinical outcomes.
    

Detailed description: 
      A- Study Design: Prospective cross-sectional analytic study

      B- Study Protocol: After attaining written informed consents from eligible STEMI/NSTEMI
      patients for participation in this observational study, data collection will be as follows: -

        1. Targeted history taking emphasizing on:

             -  Age of the patient, gender, and other risk-factors as hypertension, diabetes
                mellitus, smoking, substance abuse, dyslipidemia or family history of premature
                CAD.

             -  Symptoms as chest pain and time of onset, previous CAD related symptoms, therapies
                or revascularization procedures.

             -  Any relevant comorbid conditions.

             -  Time delays labelled as patient related delay, door-to-first medical contact, any
                delays of transfer, door-to-needle or -to-wire crossing will be recorded.

        2. Examination:

           Targeted physical examination of the patients with special emphasis on heart rate, blood
           pressure at presentation, Killip class (I-to-IV), signs suggestive of mechanical
           complications (new murmurs, pulmonary edema or cardiogenic shock).

           Patient weight and height will be collected to assess for overweight and/or obesity.

        3. Standard 12-leads surface electrocardiogram (ECG):

           It will be obtained to as part of initial diagnosis, identify rhythm disturbances (heart
           block or any other arrythmias).

           Non-standard ECG (right or posterior leads positioning) would be ordered as appropriate.

        4. Echocardiography:

           A rapid targeted bed-side study will be performed pre-cath as appropriate to assess
           LV-systolic function, regional wall motion abnormalities and any mechanical
           complication. Priority will be clearly for reperfusion, thus if the bed-side study would
           result in further delay, it will not be performed.

           All patients will have a formal and complete echo study before hospital discharge.

        5. Laboratory data:

           Venous blood sample will be obtained from all patients for biochemistry analysis.
           Cardiac biomarkers, complete blood count, coagulation profile, liver and kidney function
           testing, lipid-profile, CRP and glycated hemoglobin (HbA1c).

        6. Coronary angiography:

      Coronary angiography and PCI is considered the gold-standard modality of revascularization
      for ST-segment Elevation myocardial infarction and is recommended within 24 hours for the
      majority patients presenting with NSTEMI.

      Coronary angiography and PCI will be performed according to standard protocol. Culprit
      vessel, culprit lesion type and characteristics, initial and final TIMI flow, presence and
      number of non-culprit lesions will be collected and tabulated. Residual syntax score (rSS),
      as a surrogate for non-culprit atherosclerotic disease burden, will be equated as the
      conventional syntax score but subtracting the score of the culprit lesion(s) that have been
      passivated in the index procedure.

      C- Follow-up Patients will be followed up for at least six-months to ensure compliance to
      medical therapy and life style interventions, and to report outcome measures accurately,
      including major adverse cardiac events (MACE), rehospitalization, target lesion
      revascularization, other unplanned revascularization and/or heart failure.

      D- Data analysis By the end of the study period, the residual syntax score (rSS) will be used
      as a stratification tool to assess its correlation with outcome parameters.
    

Intervention name(s): Residual syntax score
Intervention type(s): Diagnostic Test
Intervention description(s): residual syntax score will be calculated as the conventional syntax score from the web based tool, but subtract the score of the culprit lesion(s) that are fixed (stented) in the index procedure.
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Human participants of both genders, above the age of 18 years, with acute myocardial
        infarction (STEMI and NSTEMI) coming for primary or urgent PCI, who accept to participate
        to this observational study.
      
Keywords: Residual syntax score; STEMI; NSTEMI; Myocardial infarction