Potential Utility of the SYNTAX Score 2 in Patients Undergoing Left Main Angioplasty

Abstract

BackgroundThe revascularization strategy of the left main disease is determinant for clinical outcomes.ObjectiveWe sought to 1) validate and compare the performance of the SYNTAX Score 1 and 2 for predicting major cardiovascular events at 4 years in patients who underwent unprotected left main angioplasty and 2) evaluate the long-term outcome according to the SYNTAX score 2-recommended revascularization strategy.MethodsWe retrospectively studied 132 patients from a single-centre registry who underwent unprotected left main angioplasty between March 1999 and December 2010. Discrimination and calibration of both models were assessed by ROC curve analysis, calibration curves and the Hosmer-Lemeshow test.ResultsTotal event rate was 26.5% at 4 years.The AUC for the SYNTAX Score 1 and SYNTAX Score 2 for percutaneous coronary intervention, was 0.61 (95% CI: 0.49-0.73) and 0.67 (95% CI: 0.57-0.78), respectively. Despite a good overall adjustment for both models, the SYNTAX Score 2 tended to underpredict risk. In the 47 patients (36%) who should have undergone surgery according to the SYNTAX Score 2, event rate was numerically higher (30% vs. 25%; p=0.54), and for those with a higher difference between the two SYNTAX Score 2 scores (Percutaneous coronary intervention vs. Coronary artery by-pass graft risk estimation greater than 5.7%), event rate was almost double (40% vs. 22%; p=0.2).ConclusionThe SYNTAX Score 2 may allow a better and individualized risk stratification of patients who need revascularization of an unprotected left main coronary artery. Prospective studies are needed for further validation.

Use of the SYNTAX Score II to predict mortality in interventional cardiology

“…However, newer scientific reports have shown its importance in Interventional cardiology as well, [18,19] but the fact that it also has limitations when compared with newer tools, we were compelled to further consider other tools. [20] Campos et al [6] 563 385 22 >22 2010-2014 10 He et al [7] 168 Vroegindewey et al [11] 209 210 + 209 17 (17)(18)(19)(20)(21)(22)(23)(24), > 24 2008-2013 8 Wang et al [12] 161 145 + 171 20 (20)(21)(22)(23)(24)(25)(26) [6] 66.0/66.0 76.2/76.2 ----He et al [7] 60. [8] 82.3/82.9 88.5/43.1 75.0/80.4 6.70/4.40 33.7/40.2 9.60/4.90 Magro et al [9] 62.0/67.0 66.0/72.5 31.0/35.0 21.0/20.5 3.50/11.0 52.0/39.5 Song et al [10] 50.7/63.9 99.3/65.6 58.3/71.0 68.0/67.4 30.1/37.9 74.9/47.6 Vroegindewey et al [11] 52.9/65.3 97.6/64.9 34.5/58.7 45.9/59.0 13.4/21.2 42.3/25.6 Wang et al [12] 52.0/64.5 95.0/60.6 34.8/47.7 2.50/2.20 13.0/20.0 35.7/15.4 Xu et al [13] 50.…”

Application of the SYNTAX score in interventional cardiology

“…Therefore, the SYNTAX score should be expected to at least be integrated in Interventional cardiology, despite emerging newer clinical tools, [37–39] which should but might take longer to find a place in Interventional cardiology.…”

“…Nevertheless, it should be noted that this current analysis has almost all the features that are required to be considered a well-carried out meta-analysis in terms of the total number of studies and participants, low bias risks across the studies, low levels of heterogeneity in almost all the subgroups, and well-presented robust results. Therefore, the SYNTAX score should be expected to at least be integrated in Interventional cardiology, despite emerging newer clinical tools, [ 37 – 39 ] which should but might take longer to find a place in Interventional cardiology.…”

Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery and the SYNTAX score: A systematic review and meta-analysis

“…The SYNTAX score II which is another potential tool combining clinical predictors with anatomical factors showed robust and more accurate prognosis compared to the SYNTAX score 25 . The benefits of the SYNTAX score II were further supported by other studies especially in patients with left main coronary diseases and other complex coronary artery diseases 26 27 .…”