The Impact of Residual Syntax Score as a Predictor of Major Cardiovascular Events During Treatment and 3 Months After Limited Percutaneous Coronary Intervention on Lesions Causing ST-Segment Elevation Myocardial Infarction

Kadek Sri Sasmita Dewi G*, I Kadek Susila Surya Darma, Hendy Wirawan

Abstract

Background: Acute myocardial infarction with ST-segment elevation (STEMI) is one of the leading causes of morbidity and mortality due to cardiovascular disease. In STEMI patients with multivessel disease, percutaneous coronary intervention (PCI) strategies are often limited to culprit-only PCI, leaving residual lesions that may increase the risk of major cardiovascular events (MCEs). The residual SYNTAX Score (rSS) is a quantitative tool for assessing the anatomical burden of residual coronary artery disease after intervention and is thought to have predictive value for MCE. Objective: This study aims to evaluate the role of the residual SYNTAX score as a predictor of major cardiovascular events during hospitalisation and within 3 months after limited percutaneous coronary intervention on the causative lesion in STEMI patients, as well as to determine the optimal rSS cut-off value in predicting these events. Methods: This study is an analytical observational study with a retrospective cohort design conducted at Ngoerah Hospital from January to September 2025. A total of 166 STEMI patients who underwent PCI limited to the causative lesion and met the inclusion criteria were analysed. The residual SYNTAX score was calculated based on post-PCI angiography and categorised using Receiver Operating Characteristic (ROC) analysis. Major cardiovascular events during hospitalisation and 3 months after PCI were recorded. Analyses were performed using the Chi-square test, ROC curve, and Cox regression to determine independent predictors. Results: Of the 166 patients, 64 patients (38.6%) had high rSS (≥8.5), and 102 patients (61.4%) had low rSS (<8.5). The incidence of KKM during hospitalisation was significantly higher in the high rSS group compared to the low rSS group (57.8% vs 10.8%; p<0.001). Similarly, KKM within 3 months after IKP was higher in the high rSS group (56.2% vs 13.7%; p<0.001). ROC analysis showed an rSS cut-off value of 8.5 with an AUC of 0.806 (p<0.001), sensitivity of 77.1%, and specificity of 77.1%. In multivariate analysis, high rSS was an independent predictor of KKM during hospitalisation with an HR of 4.65 (95% CI 2.26–9.58; p<0.001). Conclusion: A high residual SYNTAX score (≥8.5) is an independent predictor of major cardiovascular events during treatment and 3 months after limited percutaneous coronary intervention on the causative lesion in STEMI patients. A cut-off value of 8.5 can be used for risk stratification to identify patients with a higher risk of major cardiovascular events.

Keywords

Residual SYNTAX score; STEMI; percutaneous coronary intervention; culprit-only PCI; major cardiovascular events, risk stratification

Cite This Article

 Dewi G, K. S. S., Darma, I. K. S. S., Wirawan, H. (2026). The Impact of Residual Syntax Score as a Predictor of Major Cardiovascular Events During Treatment and 3 Months After Limited Percutaneous Coronary Intervention on Lesions Causing ST-Segment Elevation Myocardial Infarction. International Journal of Scientific Advances (IJSCIA), Volume 7| Issue 1: Jan – Feb 2026, Pages 205-216 URL: https://www.ijscia.com/wp-content/uploads/2026/02/Volume7-Issue1-Jan-Feb-No.1034-205-216.pdf

Volume 7 | Issue 1: Jan – Feb 2026