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. 2021 Apr 23;10(9):1843.
doi: 10.3390/jcm10091843.

Appropriate ICD Interventions for Ventricular Arrhythmias Are Predicted by Higher Syntax Scores I and II in Patients with Ischemic Heart Disease

Teresa Strisciuglio  1 , Giuseppe Ammirati  1 , Valerio Pergola  1 , Lucio Addeo  1 , Maria Angela Losi  1 , Aniello Viggiano  1 , Livio Imparato  1 , Vincenzo Russo  2 , Enrico Melillo  2 , Gerardo Nigro  2 , Giuseppe Stabile  3 , Antonio D'Onofrio  2 , Giovanni Esposito  1 , Antonio Rapacciuolo  1
Affiliations

Appropriate ICD Interventions for Ventricular Arrhythmias Are Predicted by Higher Syntax Scores I and II in Patients with Ischemic Heart Disease

Teresa Strisciuglio et al. J Clin Med. .

Abstract

Aims: The occurrence of ventricular arrhythmias (VAs) in ischemic heart disease (IHD) patients is related to the presence and extent of fibrotic/scar tissue. As coronary atherosclerosis is the underlying cause of myocardial ischemia and fibrosis, in IHD patients implanted with an implantable cardioverter defibrillator (ICD) we investigated the relation between the VA burden and the complexity of coronary atherosclerotic lesions.

Methods and results: In IHD patients who underwent coronary angiography and ICD implant, the Syntax scores I and II (SSI-II), as index of the severity of the coronary atherosclerotic disease, and the occurrence of VA were assessed. Overall 144 patients were included (123 males). Of these 22 patients (15%) experienced at least one episode of VA (cycle length 298 ± 19 msec) that required ICD intervention. The number of episodes per patient and per year was 4 ± 6 and 2.8 ± 4, respectively. Patients that experienced a VA compared to those free from arrhythmic events did not have distinct baseline clinical characteristics except for a higher SS I and SS II (21 (IQR 13-38) vs. 16 (IQR 10-23); p = 0.037; and 50 (IQR 39-62) vs. 42 (IQR 34-50); p = 0.012). In the binary logistic regression analyses the SS I and II were the only independent predictors of VA occurrence. A higher SS II was also associated with an earlier time to first event (p = 0.005).

Conclusion: Higher SS I-II scores reflect a more severe coronary atherosclerosis and are associated with a greater VA burden. Further studies are needed to better clarify the ability of SSI-II to stratify the risk of IHD patients to develop life-threatening VA.

Keywords: coronary artery disease; heart failure; implantable cardiac defibrillator; ventricular arrhythmias.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Assessment of SSI and SS II by looking at cine-loops of coronary angiography (upper panel). Evaluation and confirmation of each VT/VF episodes registered by the ICD (lower panel).
Figure 2
Figure 2
Whisker plots showing the relation between SS I (A) and SS II (B) in patients who experienced VT/VF episodes and in those who did not. The symbol “*” represents a significant p value < 0.05; the symbol “°” represents an outlier.
Figure 3
Figure 3
Whisker plots showing the time to recurrence of the VT/VF episode in the different quartiles of the SS II. The symbols ° represents an outlier.
See this image and copyright information in PMC

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