Prognostic Utility of the SYNTAX Score in Primary Angioplasty for STEMI and Determinants of In-hospital Death and Major Adverse Cardiovascular Events on Follow-up: A Single-center Study from Central India

Introduction Coronary artery disease is a leading global cause of mortality, particularly from acute ST-elevation myocardial infarction (STEMI). The SYNTAX score helps assess coronary complexity and guides choosing treatment options. This study evaluates its prognostic utility in primary angioplasty for ST-elevation myocardial infarction and identifies determinants of in-hospital mortality and major adverse cardiovascular events during follow-up. Methods This retrospective study at a tertiary cardiology center in Central India assessed 589 ST-elevation myocardial infarction patients who underwent primary percutaneous coronary intervention from January 2018 to June 2023. The SYNTAX score was calculated from initial angiograms, categorizing patients into low-, intermediate-, and high-risk groups. Clinical outcomes, including major adverse cardiovascular events and in-hospital mortality, were analyzed over a median follow-up of 1,278 days. Results Of the 589 patients, 456 (77.4%) completed follow-up. The mean SYNTAX score was 15.2 ± 6.71, with 82.7% classified as low risk. Major adverse cardiovascular events occurred in 73 (16.0%) patients, with 50 (10.9%) experiencing cardiovascular death. Higher SYNTAX scores were significantly linked to worse outcomes, including in-hospital mortality rates: 1.6% (score <22), 7.4% (22-32), and 12.5% (>32) ( P = .002). Multivariate analysis identified age, SYNTAX score as independent predictors of adverse outcomes, and females had more in-hospital mortality rates. Conclusion The SYNTAX score is a robust predictor of in-hospital death and short- to mid-term major adverse cardiovascular events in ST-elevation myocardial infarction patients undergoing primary angioplasty.