Fallacies and Possible Remedies of the SYNTAX Score

He, Yao; Shen, Li; Ge, Junbo

doi:10.1155/2020/8822308

Cited by 10 publications

(5 citation statements)

References 37 publications

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“…Cardiology 2021;146:690-697 DOI: 10.1159/000515759 fuse disease/small vessels are given up to be evaluated [1,2]. Our preliminary study demonstrated that the CatLet score, with a satisfactory reproducibility [3], better predicted clinical outcomes in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) than the SYNergy between PCI with TAXUS TM and Cardiac Surgery (SYNTAX) score [4].…”

Section: Introductionmentioning

confidence: 95%

Age, Serum Creatinine, and Left Ventricular Ejection Fraction Improved the Performance of the CatLet Angiographic Scoring System in Terms of Outcome Predictions for Patients with Acute Myocardial Infarction: A Median 4.3-Year Follow-Up Study

et al. 2021

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Background: We recently developed the Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system. Our preliminary study demonstrated that the CatLet score better predicted clinical outcomes than the SYNTAX score. The current study aimed at assessing whether 3 clinical variables (CVs) – age, serum creatinine, and left ventricular ejection fraction (LVEF) – improved the performance of the CatLet score in outcome predictions in patients with acute myocardial infarction (AMI). Methods: This study was a post hoc study of the CatLet score validation trial. Primary endpoint was major adverse cardiac or cerebrovascular events (MACCEs), and secondary endpoints were all-cause deaths and cardiac deaths. Results: Over 1,185 person-years (median [interquartile range], 4.3 [3.8–4.9] years), there were 64 MACCEs (20.8%), 56 all-cause deaths (18.2%), and 47 cardiac deaths (15.2%). The addition of the 3 CVs to the stand-alone CatLet score significantly increased the Harrell’s C-index by 0.0967 (p = 0.002) in MACCEs, by 0.1354 (p < 0.001) in all-cause deaths, and by 0.1187 (p = 0.001) in cardiac deaths. When compared with the stand-alone CatLet score, improved discrimination and better calibration led to a significantly refined risk stratification, particularly at the intermediate-risk category. Conclusions: CatLet score had a predicting value for clinical outcome in AMI patients. This predicting value can be improved through a combination with age, serum creatinine, and LVEF (http://www.chictr.org.cn; unique identifier: ChiCTR-POC-17013536).

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Section: Introductionmentioning

confidence: 95%

Age, Serum Creatinine, and Left Ventricular Ejection Fraction Improved the Performance of the CatLet Angiographic Scoring System in Terms of Outcome Predictions for Patients with Acute Myocardial Infarction: A Median 4.3-Year Follow-Up Study

et al. 2021

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“…The SYNTAX scores in the studies exhibited the capability of assessing the severity and complexity of CAD. The data were organized using a scoring method (He et al 2020) (Neumann et al 2019). Patients with high SYNTAX scores who underwent CABG were found to attain higher survival rates.…”

Section: Discussionmentioning

confidence: 99%

The Impact of SYNTAX Score with Longterm Outcomes of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention for Left Main Coronary Artery Disease: A Systematic Review

Murteza,

Chabib Fachry Albab,

Almas Talida Habibah

et al. 2023

FMI

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The SYNTAX score was designed to predict the postprocedural risk associated with PCI or surgical revascularization. This study aims to evaluate long term (>5 years) outcome of PCI with CABG by comparing several existing studies. A systematic search was conducted through PubMed/MEDLINE and ScienceDirect databases. This systematic review used all studies in the field of differences in outcome of PCI and CABG intervention in left main coronary artery stenosis. This study used cross sectional study design with a systematic review method based on several cohort studies. The search was conducted until February 10th, 2023. Assessment of the study quality was carried out using the criteria of the Newcastle-Ottawa Scale (NOS). Based on the final assessment, all included studies had a mean NOS score of 8 which could be interpreted as excellent quality. Our search yielded 1675 studies of which we included 5 studies for the final analysis. A total of 5.494 patients were treated with PCI and CABG. In this study, there were differences outcome in low, medium and high syntax scores on long term major adverse cardiac or cerebrovascular events (MACCE) and long term mortality. However, the similar outcome was obtained in long term revascularization, long term stroke and long term Miokard Infark (MI). Left main coronary artery (LMCA) stenosis patients with low to high SS may result various long-term outcomes. CABG is associated with lower incidence of mortality, repeat revascularization, myocardial infarction, and MACCE than PCI. Meanwhile, PCI gives lower incidence of stroke.

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“…Third, the correlation between SYNTAX scores and outcomes are small. Although many studies have supported the utility of SYNTAX scores in the selection of revascularization strategies, contradictory findings have undermined the validity of such scores (He et al 2020 ). Finally, the L-table adjusted true effects are sensitive to the input parameters.…”

Section: Discussionmentioning

confidence: 99%

Addressing unmeasured confounding bias with a prior knowledge guided approach: coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with stable ischemic heart disease

Duan

Lee

Doctor

et al. 2022

Health Serv Outcomes Res Method

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Unmeasured confounding undermines the validity of observational studies. Although randomized clinical trials (RCTs) are considered the “gold standard” of study types, we often observe divergent findings between RCTs and empirical settings. We present the “L-table”, a simulation-based, prior knowledge (e.g., RCTs) guided approach that estimates the true effect adjusting for the potential influence of unmeasured confounders when using observational data. Using electronic health record data from Kaiser Permanente Southern California, we compare the effectiveness of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) on endpoints at 1, 3, 5, and 10 years for patients with stable ischemic heart disease. We applied the L-table approach to the propensity score adjusted cohort to derive the omitted-confounder-adjusted estimated effects. After the L-table adjustment, CABG patients are 57.6% less likely to encounter major adverse cardiac and cerebrovascular event (MACCE) at 1 year (OR [95% CI] 0.424 [0.396, 0.517]), 56.4% less likely at 3 years (OR [95% CI] 0.436 [0.369, 0.527]), and 48.9% less likely at 5 years (OR [95% CI] 0.511 [0.451, 0.538]). CABG patients are also 49.5% less likely to die by the end of 10 years than PCI patients (OR [95% CI] 0.505 [0.446, 0.582]). We found the estimated true effects all shifted towards CABG as a more effective procedure that led to better health outcomes compared to PCI. Unlike existing sensitivity tools, the L-table approach explicitly lays out probable values and can therefore better support clinical decision-making. We recommend using L-table as a supplement to available techniques of sensitivity analysis. Supplementary Information The online version contains supplementary material available at 10.1007/s10742-022-00282-y.

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Fallacies and Possible Remedies of the SYNTAX Score

Cited by 10 publications

References 37 publications

Age, Serum Creatinine, and Left Ventricular Ejection Fraction Improved the Performance of the CatLet Angiographic Scoring System in Terms of Outcome Predictions for Patients with Acute Myocardial Infarction: A Median 4.3-Year Follow-Up Study

Age, Serum Creatinine, and Left Ventricular Ejection Fraction Improved the Performance of the CatLet Angiographic Scoring System in Terms of Outcome Predictions for Patients with Acute Myocardial Infarction: A Median 4.3-Year Follow-Up Study

The Impact of SYNTAX Score with Longterm Outcomes of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention for Left Main Coronary Artery Disease: A Systematic Review

Addressing unmeasured confounding bias with a prior knowledge guided approach: coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with stable ischemic heart disease

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