{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T12:01:57Z","timestamp":1784894517363,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Psychological distress is common in acute coronary syndrome (ACS), yet its relationship with objective coronary anatomical complexity is incompletely understood. The Kessler Psychological Distress Scale-10 (K10) is a brief self-report instrument that measures non-specific psychological distress over the preceding four weeks. We investigated whether the K10 score is associated with the anatomical SYNTAX I score and the clinical\u2013anatomical SYNTAX II PCI score in patients hospitalized with ACS. Materials and Methods: This prospective, single tertiary-center observational study assessed 865 adult patients with suspected or confirmed ACS between 6 January 2026 and 5 June 2026. After applying predefined inclusion and exclusion criteria, 750 consecutive eligible patients with complete K10, SYNTAX I, and SYNTAX II PCI data were included in the final analytic cohort. The cohort consisted of STEMI in 337 patients (44.9%), NSTEMI in 310 (41.3%), and unstable angina pectoris in 103 (13.7%). The validated Turkish version of the K10 scale was administered after pain control and hemodynamic stabilization, within 24\u201348 h of admission, by trained study personnel blinded to the final SYNTAX analysis. SYNTAX I and SYNTAX II PCI scores were calculated by two blinded interventional cardiologists. The primary endpoint was SYNTAX I score \u2265 23; the key secondary endpoint was SYNTAX II PCI score \u2265 36, interpreted as a cohort-based high clinical\u2013anatomical risk threshold. Results: Mean age was 61.3 \u00b1 11.6 years, and 543 patients (72.4%) were men. Mean K10, SYNTAX I, and SYNTAX II PCI scores were 23.7 \u00b1 6.7, 22.4 \u00b1 9.5, and 31.2 \u00b1 9.6, respectively. K10 score correlated with SYNTAX I (Spearman rho = 0.417, p &lt; 0.001) and SYNTAX II PCI (rho = 0.348, p &lt; 0.001). Each 5-point increase in K10 was independently associated with SYNTAX I \u2265 23 (extended model-adjusted odds ratio [OR] 1.84, 95% confidence interval [CI] 1.59\u20132.12; p &lt; 0.001) and SYNTAX II PCI \u2265 36 (extended model-adjusted OR 2.26, 95% CI 1.85\u20132.75; p &lt; 0.001). K10 predicted SYNTAX I \u2265 23 with an area under the curve (AUC) of 0.706 (95% CI 0.674\u20130.744; cutoff \u2265 24) and SYNTAX II PCI \u2265 36 with an AUC of 0.693 (95% CI 0.654\u20130.736; cutoff \u2265 26). Adding K10 to the extended clinical model improved cross-validated AUC for SYNTAX I \u2265 23 from 0.708 to 0.774 and for SYNTAX II PCI \u2265 36 from 0.871 to 0.905; bootstrap optimism-corrected AUCs were 0.754 and 0.899, respectively. The findings remained consistent in sensitivity analyses excluding prior CABG patients, adjusting for psychiatric history\/medication use, and evaluating patients whose K10 was completed before angiography. Conclusions: In this prospective ACS cohort, early in-hospital assessment of K10-defined recent psychological distress was independently associated with both anatomical and clinical\u2013anatomical coronary complexity. K10 should not replace angiographic risk scoring, but it may help identify a psychocardiological phenotype characterized by higher coronary disease burden and greater clinical vulnerability.<\/jats:p>","DOI":"10.3390\/medicina62081440","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:38:41Z","timestamp":1784889521000},"page":"1440","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Kessler-10 Psychological Distress Score Is Independently Associated with SYNTAX I and SYNTAX II Scores in Patients with Acute Coronary Syndrome"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1012-3875","authenticated-orcid":false,"given":"Fikret","family":"Keles","sequence":"first","affiliation":[{"name":"Department of Cardiology, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir 40100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alp","family":"Yildirim","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir 40100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5422-5913","authenticated-orcid":false,"given":"Ahmet Ridvan","family":"Bilgic","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Kirsehir Training and Research Hospital, Kirsehir 40100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8046-3185","authenticated-orcid":false,"given":"Muzeyyen Gizem","family":"Parmak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir 40100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1696-7449","authenticated-orcid":false,"given":"Alperen","family":"Tas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kirsehir Training and Research Hospital, Kirsehir 40100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4102-1564","authenticated-orcid":false,"given":"Mustafa","family":"Celik","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya 42090, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4099-0064","authenticated-orcid":false,"given":"Muhammet Salih","family":"Ates","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir 40100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8170-5912","authenticated-orcid":false,"given":"Erdogan","family":"Sokmen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir 40100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. 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Derivation, external validation and outcomes using the updated GRACE risk score","volume":"4","author":"Fox","year":"2014","journal-title":"BMJ Open"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1440\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:18:12Z","timestamp":1784891892000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["medicina62081440"],"URL":"https:\/\/doi.org\/10.3390\/medicina62081440","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]}}}