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The score such as TIMI and GRACE for prognostic of events are based on age, heart rate, blood pressure, etc, but not including characteristics of coronary lesions. Additionally, leman, Gensini, were not the clinical factors. While numerous previous studies have demonstrated the value of coronary artery lesion in prognostic (Syntax score), the lack of clinical factors in scores remains limited. Therefore, a combination of both clinical factors and coronary artery is necessary (clinical Syntax score) .In Vietnam, there is no research on prognostic of Syntax and clinical Syntax score in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Therefore, this study was conducted to contribute to the explanation of these above mentioned problems .
MINISTRY OF EDUCATION MINISTRY OF DEFENCE MEDICAL MILITARY UNIVERSITY NGUYEN QUANG TOAN RESEARCH ON CORONARY ARTERY LESION AND PROGNOSTIC BY SYNTAX SCORE, CLINICAL SYNTAX SCORE IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION Major: Internal Medicine Code: 9720107 HA NOI – 2020 This thesis accomplished at: Medical Military University Name of the scientific mentors: Prof. Ph. D. Pham Manh Hung Prof. Ph. D. Nguyen Oanh Oanh Revier 1: Prof. Ph. D. Nguyen Đuc Hai 108 Military Central Hospital Revier 2: Prof. Ph. D. Nguyen Lan Hieu Ha Noi Medical University Revier 3: Prof. Ph. D. Luong Cong Thuc Medical Military University Thesis will be defended at Sientific of Medical Military University Hold at………………… The thesis can be found at: Viet Nam National Library Library of Medical Military University INTRODUCTION 1. Background Myocardial infarction has been known as the leading cause of death worldwide Data derived from approximately 30 European countries showed that the rate of acute myocardial infarction with ST elevation was 44142 / 100 thousand General In hospital mortality rate was anged from 4.2% 13.5% and the mortaliry rate of patients underwent percutaneous coronary intervention (PCI) ranged from 2.7% and 8%. Studies show that the rapid restoration of flow for a narrowed or occlusion coronary artery branch is a prerequisite for determining immediate and longterm. However, the rate of major adverse cardiac events (MACE) undergoing cardiac interventions has been still high. But the prognosis of MACE for patients undergoing PCI has remained unclear. There are many characteristics and scales to help predict such as ECG, age, Leamen, Zwolle, MAYO, Gensini. However, these scales have several significant limitations so they have not been applied in clinical practices.The SYNTAX score established in 2005 inherits and develops the previous score But SYNTAX score is independent with clinical indicators Clinical SYNTAX score is a simulation of SYNTAX score when integrating clinical features (age, ejection fraction, serum creatinine clearance) by single point. Clinical SYNTAX score can be improved to predict in patients with acute myocardial infarction in the short and long term. Therefore, we conducted this study with the aim of "Research on coronary artery lesion and prognostic by SYNTAX score, clinical SYNTAX score in patients with acute myocardial infarction undergoing percutaneous coronary intervention ” Assess the level of coronary artery lesion in patients with acute myocardial infarction by SYNTAX score and clinical SYNTAX score Value of SYNTAX score, clinical SYNTAX score in prognostic of major adverse cardiovascular events in patients with acute myocardial infarction undergoing percutaneous coronary intervention 2. The necessary and urgency of the research The score such as TIMI and GRACE for prognostic of events are based on age, heart rate, blood pressure, etc, but not including characteristics of coronary lesions Additionally, leman, Gensini, were not the clinical factors. While numerous previous studies have demonstrated the value of coronary artery lesion in prognostic (Syntax score), the lack of clinical factors in scores remains limited. Therefore, a combination of both clinical factors and coronary artery is necessary (clinical Syntax score) .In Vietnam, there is no research on prognostic of Syntax and clinical Syntax score in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Therefore, this study was conducted to contribute to the explanation of these above mentioned problems 3. New contributions of the thesis The value in prognosis of major adverse cardiac events, especially mortality of SYNTAX and clinical SYNTAX scores in patients with acute myocardial infarction undergoing percutaneous coronary intervention in hospital and 1 month, 6 month, 12 month The value of clinical SYNTAX score in prognostic for mortality is better than SYNTAX score 4. Thesis Layout This thesis has 127 pages, including the following sections: Background (02 pages); General Overview (32 pages); Subjects and methods (23 pages); Results (36 pages); Discussion (31 pages); Conclusion (02 pages); Recommendation (01 page). This thesis has 51 tables, 22 charts, 10 figures This thesis has 150 references, including 14 Vietnamese references and 136 English references CHAPTER 1: GENERAL OVERVIEW 1.1. Coronary artery disease in the world and in Vietnam 1.1.1. In the world Myocardial infarction is attributed for nearly 1.8 million deaths annually in Europe., which accounts for a total of 20% of deaths. 1.1.2. In Vietnam According to Vietnam National Heart Institute (2003), the rate of acute myocardial infarction increased from 4.5% in 2003 to 9.1% in 20074.5% to 2007 was 9.1%. Particularly, in Cho Ray hospital for example, there were 7,421 hospitalizations for angina, 1,538 hospitalizations and treatments for acute coronary syndrome, and 267 deaths in 2010 1.2. Diagnosis of acute myocardial infarction * By WHO / ESC / AHA / ACC 2012 Myocardial infarction is defined as having an increase and / or decrease in myocardial biomarkers at least in excess of 99% and at least one of the following characteristics: Chest pain Change the electrocardiogram Regional movement disorder due to newly occurring myocardial ischemia by diagnostic imaging (echocardiography, MRI, ) There is evidence of coronary thrombosis on coronary angiography or autopsy 1.3. The scales to track prognosis after coronary intervention 1.3.1. SYNTAX score scale * SYNTAX score developed based on the following scores: 1. Coronary branching according to AHA (ARTS study) 2. Leaman score 3. Classification of injuries according to ACC / AHA 4. Duke and ICPS classification systems (according to Medina) * Grading steps follow SYNTAX Depending on the location of different lesions, the effect on myocardial perfusion is also different so there will be coefficients for each segment Step 1. Determine the right or left of the coronary arteries Step 2. Number of lesions of the coronary artery system Step 3. The segments of each lesion have been identified Step 4. Completely clogged coronary arteries Step 5. Lesions in place divided by 3 (Trifurcations) Step 6. Split lesions (Bifurcations) Step 7. Injury at the entrance (Aortoostial) Step 8. Serious meandering injury, is it serious? Step 9. Lesions above 20 mm long Step 10. Heavy calcium Step 11. Thrombosis Step 12. Diffuse lesions / small vessels 1.3.2. Clinical SYNTAX score * SYNTAX clinical score formula CSS = SS x (AGE / EF) + 1 (For each reduction of 10ml / min creatinine clearance 20 minutes, spreads to the neck, lower jaw or left arm, does not decrease with Nitroglycerin * Subclinical: The 12lead ECG must be recorded as soon as possible, within 10 minutes + Electrocardiogram: ST elevation compared to J point, appears in at least two consecutive leads and ≥ 0.25 mV in men under 40, ≥ 0.2 mV in men over 40, or ≥ 0.15 mV in women on V2V3 and / or ≥ 0.1 mV on other leads. In patients with inferior myocardial infarction, an ST segment elevation should be found in the right precordial leads (V3R and V4R) to determine right ventricular infarction + Nonshaped ECG: with left bundle branch block, right ventricular pacing or patient without ST elevation but persistent ischemic chest pain or ST elevation in aVR Myocardial biomarkers is routinely recommended during the acute phase but no waiting for results to be for reperfusion 2.1.2. Exclusion criteria Patient had previous coronary revascularization by surgery or percutaneous coronary intervention Patients with acute myocardial infarction with cardiogenic shock, heart rupture, ventricular septal perforation, Contraindications to using antiplatelet drugs such as aspirine, clopidogrel or contrast medicine There are serious comorbidities such as severe renal impairment, severe liver failure, terminal cancer, diabetic coma Patients do not agree for study 2.2. Methods 2.2.1. Research design: cross sectional description, vertical tracking. 2.2.2. Content and methods The participants were selected from a unified patient sample including risk factors for coronary artery disease, clinical symptoms of acute myocardial infarction, subclinical , intervention. * Calculate SYNTAX scores, clinical SYNTAX scores Based on the recorded coronary angiography image, we identify coronary artery lesions according to coronary anatomy classification. We through the Calculator syntax sore 2.11 calculator Clinical SYNTAX score calculator The formula: CSS = SS x (AGE / EF) + 1 (For each reduction of 10ml / ph Creatinine clearance