Serum Leptin and SYNTAX Score in Acute Coronary Syndrome: Insights from a Prospective Observational Study for Risk Stratification

Background: Risk stratification in patients with acute coronary syndrome (ACS) remains a clinical challenge. Serum leptin, an adipocyte-derived hormone, has been implicated in atherosclerosis and cardiovascular risk, but its relationship with angiographic complexity, as assessed by the SYNTAX score, is not fully established. This study aimed to evaluate the association between serum leptin levels and SYNTAX score in patients with ACS undergoing primary percutaneous coronary intervention (PPCI). Methods: This prospective observational study included 100 patients diagnosed with ACS (ST-elevation myocardial infarction [STEMI] and high-risk non–ST-elevation myocardial infarction [NSTEMI]) who underwent PPCI at Tanta University Hospitals and El Sahel Teaching Hospital between January and June 2024. Clinical data, cardiovascular risk factors, laboratory investigations, and serum leptin levels were obtained. Coronary angiography was performed, and SYNTAX scores were calculated using the online scoring system. Patients were categorized into low (≤22), intermediate (23-32), and high (³33) SYNTAX score groups. Associations between leptin levels and SYNTAX score were analyzed. Results: Serum leptin levels were significantly higher in patients with high SYNTAX scores compared to those in the low and intermediate groups (p < 0.05). Leptin levels showed a positive correlation with SYNTAX score. Traditional cardiovascular risk factors, including diabetes mellitus, hypertension, and dyslipidemia, were also more prevalent in the high SYNTAX score group. Conclusion: Elevated serum leptin levels are associated with increased coronary lesion complexity, as reflected by higher SYNTAX scores, in patients with ACS undergoing PPCI. Measurement of serum leptin may provide additional value in risk stratification and prognostication in ACS. Clinical trial number: not applicable.