MINISTRY OF EDUCATION MINISTRY OF DEFENCE
MEDICAL MILITARY UNIVERSITY
NGUYEN QUANG TOAN
RESEARCH ON CORONARY ARTERY LESION AND
PROGNOSTIC BY SYNTAX SCORE, CLINICAL SYNTAX
SCORE IN PATIENTS WITH ACUTE MYOCARDIAL
INFARCTION UNDERGOING PERCUTANEOUS
CORONARY INTERVENTION
Major: Internal Medicine
Code: 9720107
HA NOI – 2020
This thesis accomplished at:
Medical Military University
Name of the scientific mentors:
1. Prof. Ph. D. Pham Manh Hung
2. Prof. Ph. D. Nguyen Oanh Oanh
Revier 1: Prof. Ph. D. Nguyen Đuc Hai
108 Military Central Hospital
Revier 2: Prof. Ph. D. Nguyen Lan Hieu
Ha Noi Medical University
Revier 3: Prof. Ph. D. Luong Cong Thuc
Medical Military University
Thesis will be defended at Sientific of Medical Military University
Hold at…………………
The thesis can be found at:
1. Viet Nam National Library
Library of Medical Military University
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INTRODUCTION
1. Background
Myocardial infarction has been known as the leading cause of
death worldwide. Data derived from approximately 30 European
countries showed that the rate of acute myocardial infarction with
ST elevation was 44-142 / 100 thousand. General In- hospital
mortality rate was anged from 4.2% - 13.5% and the mortaliry rate of
patients underwent percutaneous coronary intervention (PCI) ranged
from 2.7% and 8%. Studies show that the rapid restoration of flow
for a narrowed or occlusion coronary artery branch is a prerequisite
for determining immediate and long-term. However, the rate of major
adverse cardiac events (MACE) undergoing cardiac interventions has
been still high. But the prognosis of MACE for patients undergoing
PCI has remained unclear. There are many characteristics and scales
to help predict such as ECG, age, Leamen, Zwolle, MAYO, Gensini.
However, these scales have several significant limitations so they
have not been applied in clinical practices.The SYNTAX score
established in 2005 inherits and develops the previous score. But
SYNTAX score is independent with clinical indicators. Clinical
SYNTAX score is a simulation of SYNTAX score when integrating
clinical features (age, ejection fraction, serum creatinine clearance)
by single point. Clinical SYNTAX score can be improved to predict
in patients with acute myocardial infarction in the short and long
term. Therefore, we conducted this study with the aim of "Research
on coronary artery lesion and prognostic by SYNTAX score, clinical
SYNTAX score in patients with acute myocardial infarction
undergoing percutaneous coronary intervention ”.
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1. Assess the level of coronary artery lesion in patients with
acute myocardial infarction by SYNTAX score and clinical
SYNTAX score.
2. Value of SYNTAX score, clinical SYNTAX score in
prognostic of major adverse cardiovascular events in patients with
acute myocardial infarction undergoing percutaneous coronary
intervention.
2. The necessary and urgency of the research
The score such as TIMI and GRACE for prognostic of events are
based on age, heart rate, blood pressure, etc, but not including
characteristics of coronary lesions. Additionally, leman, Gensini,
were not the clinical factors. While numerous previous studies have
demonstrated the value of coronary artery lesion in prognostic
(Syntax score), the lack of clinical factors in scores remains limited.
Therefore, a combination of both clinical factors and coronary artery
is necessary (clinical Syntax score) .In Vietnam, there is no research
on prognostic of Syntax and clinical Syntax score in patients with acute
myocardial infarction undergoing percutaneous coronary intervention.
Therefore, this study was conducted to contribute to the explanation of
these above mentioned problems .
3. New contributions of the thesis
The value in prognosis of major adverse cardiac events,
especially mortality of SYNTAX and clinical SYNTAX scores in
patients with acute myocardial infarction undergoing percutaneous
coronary intervention in hospital and 1 month, 6 month, 12 month.
The value of clinical SYNTAX score in prognostic for mortality
is better than SYNTAX score.
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4. Thesis Lay-out
This thesis has 127 pages, including the following sections:
Background (02 pages); General Overview (32 pages); Subjects and
methods (23 pages); Results (36 pages); Discussion (31 pages);
Conclusion (02 pages); Recommendation (01 page). This thesis has
51 tables, 22 charts, 10 figures. This thesis has 150 references,
including 14 Vietnamese references and 136 English references.
CHAPTER 1: GENERAL OVERVIEW
1.1. Coronary artery disease in the world and in Vietnam
1.1.1. In the world
Myocardial infarction is attributed for nearly 1.8 million deaths
annually in Europe., which accounts for a total of 20% of deaths.
1.1.2. In Vietnam
According to Vietnam National Heart Institute (2003), the rate
of acute myocardial infarction increased from 4.5% in 2003 to 9.1%
in 20074.5% to 2007 was 9.1%. Particularly, in Cho Ray hospital for
example, there were 7,421 hospitalizations for angina, 1,538
hospitalizations and treatments for acute coronary syndrome, and 267
deaths in 2010.
1.2. Diagnosis of acute myocardial infarction
* By WHO / ESC / AHA / ACC 2012
Myocardial infarction is defined as having an increase and / or
decrease in myocardial biomarkers at least in excess of 99% and at
least one of the following characteristics:
- Chest pain.
- Change the electrocardiogram.