Page 117 - EJMO-9-1

Eurasian Journal of Medicine and
Oncology
HEART and SYNTAX scores

management. Unlike ST-elevation myocardial infarction age, risk factors, and troponin levels – is designed to
(STEMI), in which characteristic ST-segment elevation estimate a patient’s short-term risk of experiencing major
on electrocardiogram (ECG) signals an urgent need adverse cardiac events, such as myocardial infarction,
for revascularization, NSTE-ACS lacks this definitive revascularization, and death. It is valued in emergency
4
marker, presenting unique diagnostic challenges. Patients settings requiring rapid assessment considering it integrates
with NSTE-ACS may experience chest pain symptoms clinical and laboratory data into a single, accessible tool.
similar to those with STEMI; however, the absence of In contrast, the SYNTAX score was developed to assess
ST-segment elevation complicates early identification and the CAD complexity. Based on the coronary angiography
risk assessment, often necessitating a nuanced approach findings, the SYNTAX score give a numerical value
to diagnosis and treatment. The increasing incidence of that reflects the anatomical complexity of coronary
1
NSTE-ACS can be attributed to the rising prevalence of lesions, including the location and severity of stenosis,
associated risk factors, including hypertension, diabetes, involvement of major arteries, and presence of bifurcation
hyperlipidemia, and smoking. With aging populations lesions. Although it is a valuable predictor of procedural
5
and lifestyle factors such as diet and physical activity outcomes in patients undergoing percutaneous coronary
contributing to cardiovascular risk, an increasing number intervention (PCI), the SYNTAX score requires invasive
of individuals are developing conditions that predispose imaging, making it less accessible in emergency settings.
them to coronary artery disease (CAD). These risk factors Nonetheless, the SYNTAX score is widely regarded as a
2
often converge at NSTE-ACS, further developing complex robust tool for assessing coronary lesion complexity and
coronary lesions. Given the heterogeneity of NSTE-ACS predicting outcomes in patients with established CAD.
6
presentations, clinical outcomes for patients can widely Combining the HEART and SYNTAX scores could offer a
vary, thereby underscoring the need for effective and risk powerful approach to assessing patients with NSTE-ACS.
stratification tools that can guide appropriate therapeutic Although the HEART score enables non-invasive, rapid
strategies. In recent years, clinicians have increasingly risk stratification based on initial clinical and laboratory
3
relied on clinical risk scores to evaluate the likelihood of findings, the SYNTAX score vividly shows the coronary
adverse cardiac events in patients with NSTE-ACS. Among anatomy. By exploring the relationship between these two
these scoring systems, the HEART score has gained scoring systems, clinicians can improve their ability to
prominence for its simplicity and predictive power. The identify patients with complex coronary lesions who may
HEART score (Table 1) – assessing history, ECG findings, benefit from intensive treatment or early intervention.

Table 1. HEART score This study aimed to bridge the gap between non-
invasive and invasive assessment methods by examining
History Highly suspicious 2 points the predictive value of the HEART score for coronary
Moderately suspicious 1 point lesion complexity, as defined by the SYNTAX score, in
Slightly or non-suspicious 0 points patients with NSTE-ACS. By determining whether a
ECG Significant ST-deviation 2 points high HEART score correlates with a high SYNTAX score,
Non-specific repolarization disturbance 1 point we aim to establish a practical approach for the early
Normal 0 points identification of patients with complex coronary anatomy
and facilitate prompt and tailored therapeutic decisions.
Age ≥65 years 2 points
>45 – 65 years 1 point This approach could have remarkable implications in
emergency and outpatient settings, where efficient triage
≤45 years 0 points and targeted treatment are essential for optimal patient
Risk factors* ≥3 risk factors or history of 2 points outcomes.
atherosclerotic disease
1 or 2 risk factors 1 point 2. Methods
No risk factors known 0 points 2.1. Study design and population
Troponin ≥3×normal limit 2 points
1 – 3×normal limit 1 point This cross-sect`ional study included patients diagnosed
with NSTE-ACS admitted to Trung Vuong Hospital
≤Normal limit 0 points between December 2023 and September 2024. Patients with
Note: *Risk factors for atherosclerotic disease: hypercholesterolemia, symptoms consistent with unstable angina or non-STEMI
cigarette smoking, hypertension, family history of CAD, diabetes were included in the study, whereas those with left bundle
mellitus, and obesity (BMI>30 kg/m ).
2
Abbreviations: BMI: Body mass index; CAD: Coronary artery disease; branch block or previous coronary revascularization were
ECG: Electrocardiogram. excluded from the study.

Volume 9 Issue 1 (2025) 109 doi: 10.36922/ejmo.5731