P5808Impact of SYNTAX score on release of cardiac biomarkers in post-revascularization procedures among patients with stable multivessel disease: MASS-V insights

Abstract

Background: Abnormal cardiac enzymes release post-revascularization procedure has been associated with worse clinical outcomes, including cardiovascular events. However, levels of myocardial biomarkers post revascularization procedural have not been associated with the severity of coronary artery disease (CAD). Purpose: To investigate the correlation between cardiac biomarkers elevation post-revascularization proceduresand angiographic complexity of CAD assessed by SYNTAX score (SXscore). Methods: This is an ancillary study of MASS V trial, which was a single-center, prospective and observational study among patients with stable CAD who underwent percutaneous or surgical revascularizationprocedures. Hs-TnI and CKMB were assessed before and after procedures. The SXscore was calculated from baseline angiograms by two interventional cardiologists who were blinded to blood sample data. Results: Of the 202 patients studied, 136 (67.3%) underwent CABG and 66 (32.7%) PCI. Triple-vessel disease was present in 137 patients (62%), with 92% involvement of the anterior descending artery. A total of 2,706 hs-TnI and CK-MB samples were obtained from the CABG and PCI patients, yielding a mean of 13.3 samples per biomarker per patient. The mean SXscore was 21.2±9.2 in revascularized patients, 23.3±9.2 in the CABG stratum and 17.0±7.7 in PCI stratum. SXscore correlates with peak post-procedural hs-TnI (p=0.009) and CK-MB (p=0.001) levels and release of hs-TnI pos procedural at 6 hours (p<0.0001), 12 hours (p<0.0001), 24 hours (p=0.026) and 36 hours (p=0.049) and CK-MB at 6 hours (p<0.0001), 12 hours (p<0.0001), 24 hours (p=0.001), 36 hours (p=0.001) and 48 hours (p=0.001). Besides, CK-MB presented a correlation at 6 hours (p=0.006), 12 hours (p=0.001) and 24 hours (p=0.005) in the CABG stratum. The levels of hs-TnI at 6 hours (p=0.015) and 12 hours (p=0.039) and CK-MB at 6 hours (p=0.002), 12 hours (p=0.004) and 24hours (p=0.021) were different in patients with low, medium and high SXscore respectively. In patients with high SXscore (≥33) the release of hs-TnI at 6 hours (p<0.002), 12 hours (p<0.008) and 24 hours (p=0.039), was higher than low/mid SXscore (<33), as well as, the release of CK-MB at 6 hours (p<0.0001), 12 hours (p<0.0001), 24 hours (p=0.001), 36 hours (p=0.007), 48 hours (p=0.008) and 72 hours (p=0.023), in the same groups. Conclusions: In patients with stable coronary artery disease undergoing elective revascularization procedure, an increase in post-procedural hs-TnT and CK-MB levels showed significant correlation with angiographic atherosclerotic extent and burden, as assessed as SXscore.