Aortic Wall Extracellular Matrix Proteins Correlate with Syntax Score in Patients Undergoing Coronary Artery Bypass Surgery

Terri Chiong1, Esther S. H. Cheow2, Chin C. Woo1, Xiao Y. Lin3, Lay W. Khin1, 4, Chuen N. Lee1, 3, Mikael Hartman1, 5, Siu K. Sze2, Vitaly A. Sorokin1, 3, *
1 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
2 School of Biological Sciences, Nanyang Technological University, Singapore
3 Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, National University Health System, Singapore
4 Investigational Medicine Unit, National University of Singapore, National University Health System, Singapore
5 Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore

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© Chiong et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

Correspondence: *Address correspondence to this author at the Department of Cardiac, Thoracic & Vascular Surgery, National University Health System, Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228; Tel: +65 67726507; Fax: +65 67766475; Email:



The SYNTAX score correlate with major cardiovascular events post-revascularization, although the histopathological basis is unclear. We aim to evaluate the association between syntax score and extracellular matrix histological characteristics of aortic punch tissue obtained during coronary artery bypass surgery (CABG). This analysis compares coronary artery bypass surgery patients with High and Low syntax score which were followed up for one year period.

Methods and Results:

Patients with High (score ≥ 33, (n=77)) and Low Syntax Scores (score ≤ 22, (n=71)) undergoing elective CABG were recruited prospectively. Baseline clinical characteristics and surgical risks were well matched. At 1 year, EMACCE (Sum of cardiovascular death, stroke, congestive cardiac failure, and limb, gut and myocardial ischemia) was significantly elevated in the High syntax group (P=0.022). Mass spectrometry (MS)-based quantitative iTRAQ proteomic results validated on independent cohort by immunohistochemistry (IHC) revealed that the High syntax group had significantly upraised Collagen I (P<0.0001) and Elastin (P<0.0001) content in ascending aortic wall.


This study shows that aortic extracellular matrix (ECM) differ between High and Low syntax groups with up-regulation of Collagen I and Elastin level in High Syntax Score group. This identifies aortic punches collected during CABG as another biomarker source related with atherosclerosis severity and possible clinical outcome.

Keywords: Collagen, Elastin, EMACCE, Extracellular matrix, Syntax.