Prognostic value of the syntax score in patients undergoing coronary artery bypass grafting for three‐vessel coronary artery disease

Abstract

Unlike for PCI, the Syntax score has a poor prognostic value for severe cardiovascular events in patients undergoing CABG for 3-vessel CAD. Other risk scores should be used to predict the outcome of this population.

A Global Risk Approach to Identify Patients With Left Main or 3-Vessel Disease Who Could Safely and Efficaciously Be Treated With Percutaneous Coronary Intervention

“…The SYNTAX score (SXscore) (1)(2)(3)(4) has established itself as an important tool in the SYNTAX trial (The Synergy between PCI with TAXUS and Cardiac Surgery Trial) pioneered Heart Team approach, in which the cardiac surgeon and interventional cardiologist determined the optimal revascularization modality for patients with untreated left main stem (LMS) or 3-vessel (3VD) coronary artery disease (1,(5)(6)(7). The SXscore has since been validated in the LMS percutaneous coronary intervention (PCI) population at short-and long-term follow-up (8 -11); the 3VD PCI population at short-term (1-year) follow-up (12,13); and "All-Comers" patients undergoing PCI in contemporary stent trials at 1-year follow-up (14,15). In addition, both the current U.S. and European Guidelines on myocardial revascularization (16 -18) advocate the use of the SXscore to determine the optimal revascularization modality in patients with unprotected left main or complex coronary disease, without the explicit use of clinical variables.…”

Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) Score for Prediction of Outcomes After Unprotected Left Main Coronary Revascularization

“…Subsequently, studies in patients with ULMCA stenosis supported the effectiveness of the SYNTAX score in predicting mortality after PCI or CABG (35,36) or myonecrosis after PCI (37). The other studies, however, found that the SYNTAX score was poor when used to predict long-term mortality or TVR after CABG or DES implantation (38). Generalization of these Kim et al The SYNTAX Score for LM Revascularization results assessing the role of the SYNTAX score, however, is limited by small sample sizes, variations in follow-up time, or selected patient enrollment.…”

“…On the contrary, the SYNTAX score lost even the slight predictive ability for patients undergoing CABG, as shown by the C-index value of 0.53. Because the grafts are bypassed downstream of the lesions in CABG surgery, angiographic complexity might have little clinical impact (17,38). Furthermore, in comparison of the 2 scores, the EuroSCORE was more effective in predicting the risk of MAVE after PCI and CABG and the risk of MACCE after CABG, whereas the SYNTAX score was more effective in predicting the risk of MACCE only after DES treatment.…”

Usefulness of SYNTAX Score to Select Patients With Left Main Coronary Artery Disease to Be Treated With Coronary Artery Bypass Graft

“…The prognostic utility of the SYNTAX score has been recently validated in different settings, including patients with 3-vessel (8,9) or left main CAD (10,11) undergoing either PCI or CABG. However, the SYNTAX score has been originally proposed as an aid to decision making for PCI patient selection more than as a predictive tool for stratifying individual outcomes of patients undergoing either procedure.…”