Page 119 - EJMO-9-1

Eurasian Journal of Medicine and
Oncology
HEART and SYNTAX scores

Table 3. Risk according to the GRACE score of the group with moderate‑to‑high SYNTAX and low SYNTAX scores
Variable Moderate‑to‑high SYNTAX score (%) Low SYNTAX score (%) Total (%) P
Low risk (GRACE <109) 36 (56.3) 47 (83.9) 83 (69.2) 0.001*
Moderate-to-high (GRACE ≥109) 28 (43.8) 9 (16.1) 37 (30.8)
Total 64 (100) 56 (100) 120 (100)
Notes: The proportion of patients with moderate-to-high risk according to the GRACE score in the group with moderate-to-high SYNTAX scores was
43.8%, which is higher than that in the group with low SYNTAX scores (16.1%). The difference in risk according to the GRACE score between the
group with moderate-to-high SYNTAX scores and the group with low SYNTAX scores was significant (ꭓ test, P=0.001).
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SYNTAX score. Reportedly, patients with high HEART
scores are more likely to exhibit complex coronary lesions,
7-9
as measured by the SYNTAX score. Herein, patients
with a HEART score of ≥5 showed a significantly higher
likelihood of a SYNTAX score of ≥23, which aligns with
Salimi et al.’s findings. In addition, Six et al. validated the
8
HEART score as a reliable tool for emergency cardiology
settings, demonstrating its efficacy in stratifying patients
who are at risk of coronary complications. This underscores
4
the utility of the HEART score as a non-invasive measure
that correlates with the anatomical complexity captured by
the SYNTAX score. Several mechanisms might explain the
Figure 1. Correlation between the HEART and SYNTAX scores
predictive relationship between the HEART and SYNTAX
scores. The HEART score components – particularly ECG
findings, age, and troponin levels – reflect functional and
biochemical markers of ischemic burden, which are closely
linked to the extent of CAD. Although primarily anatomical,
the SYNTAX score is strongly influenced by the degree of
stenosis, presence of bifurcation lesions, and overall lesion
distribution, which are often more pronounced in patients
5
with high HEART scores. In NSTE-ACS, high troponin
levels indicate myocardial injury, which can correspond to
more complex coronary lesions when observed along with
risk factors, as captured in the HEART score framework;
this relationship indicates that higher HEART scores are
predictive of adverse events and may signal the anatomical
burden of disease that requires intensive management.
Figure 2. ROC curve of the HEART score in predicting moderate-to-high 4.2. Comparison on predicting long-term mortality
SYNTAX scores and adverse outcomes in ACS with the GRACE score
Abbreviation: ROC: Receiver operating characteristic.
The HEART and GRACE scores are widely used tools for
associations in univariate analysis, they do not maintain assessing risk in patients with ACS; however, they have
significance in multivariate analysis, underscoring the distinct strengths and limitations. Herein, the HEART
importance of the HEART score and men in predicting score demonstrated a superior predictive value for
moderate-to-high SYNTAX scores (≥23) with an AUC
lesion severity (Table 4).
of 0.912, indicating excellent discrimination. In contrast,
4. Discussion although highly regarded for predicting long-term
mortality and adverse outcomes in ACS, the GRACE score
4.1. Comparison with existing studies is less effective for predicting the complexity of coronary
The study results align closely with that of previous studies, lesions, with an AUC of 0.689 (Figure 3).
affirming the predictive value of the HEART score in The integration of the HEART score in clinical and
assessing coronary artery complexity, as indicated by the laboratory parameters allows rapid, bedside assessment,

Volume 9 Issue 1 (2025) 111 doi: 10.36922/ejmo.5731