Objective: The complexity of coronary artery disease (CAD) poses a challenge during percutaneous coronary interventions. Although it
is well-defined in patients with stable ischemic heart disease, its prognostic implication and effect on myocardial injury are not demonstrated well in patients with acute coronary syndrome (ACS).
Methods: We enrolled 313 patients with ACS (149 ST-elevated myocardial infarction and 164 ACS without ST elevation) in this study. The
complexity of CAD was decided using SYNTAX score (SxS). Amount of myocardial injury was determined according to high-sensitive
troponin and creatine-kinase levels. Clinical outcomes were reinfarction, revascularization, and cardiac death.
Results: Thrombolysis in myocardial infarction and global registry of acute coronary events risk scores were significantly higher in patients with
high SxS (p=0.007 and p<0.001, respectively). There was no significant difference in cardiac biomarkers (p=0.429 for troponin and p=0.253
for creatinine kinase myocardial band). Ejection fraction was significantly lower in patients with high SxS (p=0.006). Clinical endpoints were
similar between syntax groups (p=0.402 for reinfarction and p=0.342 for cardiac death) except revascularization. Revascularization was higher
in patients with high SxS (p=0.007). When patients in ST-segment elevated myocardial infarction and non–ST-segment elevated myocardial
infarction/unstable angina pectoris groups were examined together, clinical endpoints were significantly higher in the high SxS group.
Conclusion: Our study demonstrated that the complexity of CAD in patients with ACS is associated with adverse clinical outcomes but
not with myocardial injury.
Keywords: Acute coronary syndrome, coronary artery disease, myocardial injury