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...hased-array transducer. Recordingsswere taken with patients positioned in the left lateral decubitus position. The left ventricular ejection fraction (LVEF) wassmeasured using modified Simpson’s rule =-=[12]-=-. Coronary angiography, primary angioplastysand stenting All patients received 300-mg chewable aspirin and 600-mgsloading dose of clopidogrel before coronary angiography.sEmergency coronary angiograph...

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...angiography was performed by the percutaneous femoral approach. In all cases, a nonionic low-osmolality contrast media was used. The infarct-related arteryswas graded according to TIMI classification =-=[13]-=-. The grade ofscoronary collateral development was determined accordingsto the Cohen-Rentrop method [14]. Heparin (100 U/kg) wassadministered when coronary anatomy was first assessed. Thesusage of tir...

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...ormation to the Ss.sIn the era of primary PCI, several different clinical scoresshave been used, including the Global Registry of Acute Coronary Events [24], primary angioplasty in MI [4], TIMI-STEMIs=-=[2]-=-, Zs [3], and controlled abciximab and device investigationsto lower late angioplasty complications (CADILLAC) risk scores[5]. The first three of these scores have become outdatedsbecause of insuffici...

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...ochemistry and complete blood countsmeasurements were carried out using standard methods. Thesglomerular filtration rate was estimated by the simplified modification of diet in renal disease equation =-=[11]-=-. ThrombolysissIn Myocardial Infarction (TIMI) risk score was calculatedsfrom medical history, angiographic and haemodynamic values. A transthoracic echocardiography was performed usingsa Philips HD11...

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...were developed beforesthe primary percutaneous coronary revascularisation (PCI) era.sThe Syntax score (Ss) has been validated as an angiographicsscoring system in stable coronary artery disease (CAD) =-=[6]-=-.sSubsequently, it was studied in STEMI patients, and it wassshown that the Ss yielded a similar prognostic value in STEMIs[7–10]. The Zwolle score (Zs) is a scoring system that consistssof clinical a...

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...contrast media was used. The infarct-related arteryswas graded according to TIMI classification [13]. The grade ofscoronary collateral development was determined accordingsto the Cohen-Rentrop method =-=[14]-=-. Heparin (100 U/kg) wassadministered when coronary anatomy was first assessed. Thesusage of tirofiban was left to the opinion of the operator.sSyntax and Zwolle score Syntax score was calculated for ...

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...prognostic value obtained by addingsclinical information to the Ss.sIn the era of primary PCI, several different clinical scoresshave been used, including the Global Registry of Acute Coronary Events =-=[24]-=-, primary angioplasty in MI [4], TIMI-STEMIs[2], Zs [3], and controlled abciximab and device investigationsto lower late angioplasty complications (CADILLAC) risk scores[5]. The first three of these s...

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...y of Acute Coronary Events [24], primary angioplasty in MI [4], TIMI-STEMIs[2], Zs [3], and controlled abciximab and device investigationsto lower late angioplasty complications (CADILLAC) risk scores=-=[5]-=-. The first three of these scores have become outdatedsbecause of insufficient data about procedural variables suchsas post-TIMI flow. The CADILLAC risk score has been usefulsin terms of its prognosti...

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...ng system, patients admitted with cardiogenic shocksand a complex coronary anatomy (e.g. left main or bifurcation disease) were excluded. Also, pain-to-balloon time,swhich is associated with survival =-=[25]-=-, was not evaluated.sThe Zs, which was created by De Luca et al. [3], can be usedsto identify a large cohort (73.4%) of low-risk (£ 3 points)spatients, with a good discriminatory capacity (c statistic...

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...e ‘smokingsparadox’ was clearly seen between groups. The smokingsparadox became known through studies showing that smokers, compared to non-smokers, experienced a better outcomesfollowing an acute MI =-=[26]-=-. However, the paradox could notsbe verified in all cases. For example, Weisz et al. [27] arguedsthat the protective effect of smoking may be explained bysdifferences in baseline risk rather than smok...

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...veloped risk scores using the Ss andsclinical variables. For example, Garg et al. [8] compared the Sssin isolation and in combination with the primary angioplastysin MI score (a clinical-based score) =-=[4]-=-. Together, the Ss andsprimary angioplasty in MI score led to a net reclassificationsimprovement in mortality and MACE in patients undergoing primary PCI. Another study evaluated the ability of thesSs...

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....sST-elevation myocardial infarction (STEMI) is one of the mostsdangerous forms of ACS. Despite the improvement of differentstherapeutic modalities, major adverse cardiac events (MACE)sare still 8.7% =-=[1]-=-. Various risk scores have been introduced insSTEMI over time [2–5], most of which were developed beforesthe primary percutaneous coronary revascularisation (PCI) era.sThe Syntax score (Ss) has been v...

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...ivestherapy because the Ss provides additional risk stratificationsof standard risk scores. In addition, they found an independent association between a high Ss (> 21) and no reflow aftersprimary PCI =-=[10]-=-. Palmerini et al. [20] reported that in patientsswith a non-STEMI undergoing PCI, the Ss was an independent predictor of the one-year rate of death, cardiac death,sMI, and tricuspid valve replacement...

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...yielded a similar prognostic value in STEMIs[7–10]. The Zwolle score (Zs) is a scoring system that consistssof clinical and angiographic variables, and it helped in thesprognostic assessment of STEMI =-=[3]-=-. The present study wassaimed to evolve a simple, practical, and sensitive risk scoreswww.kardiologiapolska.pl Combined Zwolle and Syntax score in STEMI 147 by including factors of clinical and angiog...

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...g et al. [8] discovered that the incidencesof all clinical outcomes, including mortality, MACE, and stentsthrombosis, after one year was highest in patients in the topsSs tertile (> 16). Magro et al. =-=[9]-=- argued that STEMI patientsswith a high Ss were at high risk for long-term mortality andsMACE, and that these patients may need more intensivestherapy because the Ss provides additional risk stratific...

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...ntrast-induced nephropathy (CIN) was defined as a relative increase in baseline serum creatinine of greater than 25%sand/or an absolute increase of 0.5 mg/dL within 72 h afterscontrast administration =-=[15]-=-. Advanced heart failure was defined as a New York Heart Association classification of at leasts3. Cardiovascular mortality was defined as unexplained suddensdeath or death as a result of acute MI, he...

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... Ss provides additional risk stratificationsof standard risk scores. In addition, they found an independent association between a high Ss (> 21) and no reflow aftersprimary PCI [10]. Palmerini et al. =-=[20]-=- reported that in patientsswith a non-STEMI undergoing PCI, the Ss was an independent predictor of the one-year rate of death, cardiac death,sMI, and tricuspid valve replacement. In a recent study bys...

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... an independent long-term predictor of mortality andsMACE [17–19]. Later studies were conducted in patients withsSTEMI. In a study of 807 patients with acute STEMI undergoing primary PCI, Garg et al. =-=[8]-=- discovered that the incidencesof all clinical outcomes, including mortality, MACE, and stentsthrombosis, after one year was highest in patients in the topsSs tertile (> 16). Magro et al. [9] argued t...

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... it is not completely comprehensive, has poorscalibration, does not include clinical parameters, does notsdiscriminate ischaemia, has only moderate reproducibility,sand is time-consuming to determine =-=[29]-=-. In the CADILLACsscore, LVEF is the most powerful prognostic predictor, but thesZs does not include LVEF. CONCLUSIONS In this study, we combined the Zs and Ss for the first time. Thisscombination acc...

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...< 0.001)sand Syntax score (Ss) (AUC 0.802, 95% CI 0.686–0.918,sp < 0.001); MACE — major adverse cardiac events; restsabbreviations as in Table 1 www.kardiologiapolska.pl Seref Kul et al. 152 our team =-=[7]-=-, patients with a high Ss (> 21.75) undergoingsprimary angioplasty for STEMI had poorer in-hospital survival,sand a high Ss was an independent risk factor for in-hospitalscardiovascular mortality. The...

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...ity ofsCAD in patients undergoing PCI and to aid communicationsbetween surgeons and interventional cardiologists in identifying the optimal revascularisation strategy in patients withscomplex lesions =-=[6, 16]-=-. The findings of initial studies, whichswere performed in patients with stable CAD, revealed thatsthe Ss is an independent long-term predictor of mortality andsMACE [17–19]. Later studies were conduc...

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...rtality and MACE in patients undergoing primary PCI. Another study evaluated the ability of thesSs and clinical Ss (CSs) to predict long-term outcomes in allspopulations receiving drug-eluting stents =-=[21]-=-. The CSs wasscalculated by combining the Ss with variables such as age,sbaseline LVEF, and creatinine clearance. The CSs advancedsthe predictivity of the Ss for five-year all-cause mortality. Usingst...

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.... The CSs advancedsthe predictivity of the Ss for five-year all-cause mortality. Usingsthe data from the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, Nam et al. =-=[22]-=-scalculated the Ss by incorporating only ischaemia-producingslesions as determined by a fractional flow reserve £ 0.80; theyscalled this score the functional Ss (FSs). The FSs decreased thesnumber of ...

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...hesnumber of higher-risk patients by moving one-third of themsto a lower risk category, and compared to the Ss, the FSs hadsbetter predictive accuracy for MACE at one-year follow-up.sCapodanno et al. =-=[23]-=- produced another risk score calledsthe global risk classification system, which was created byscombining the Ss and EuroSCORE strata. The inclusion of thesEuroSCORE in an Ss-based model significantly...

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...be verified in all cases. For example, Weisz et al. [27] arguedsthat the protective effect of smoking may be explained bysdifferences in baseline risk rather than smoking status persse. Cornel et al. =-=[28]-=- revealed that habitual smoking was associated with a greater risk of subsequent stent thrombosissin patients hospitalised with ACS. It seems that conflictingsresults will continue.sNot surprisingly, ...