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Syntax Score (SS) is an important measure to standardize coronary revascularization indications and has been used worldwide. The discrepancy in SS between angiographic core lab (ACL) and personnel has been published. As SS was not normally used in China, the discrepancy might be more serious. However, the accuracy of subjective SS category assessment during coronary angiography remains unknown in China.
From 15/8/2016 to 25/10/2016, 528 patients of Fuwai Hospital with syntax score>0 by ACL were continuously recruited. Patients' cardiologists (n=27) were asked subjective SS category assessment (low, intermediate, high risk) right after the coronary angiography. All angiograms were reviewed by ACL. Agreement between ACL and cardiologists' judgment was used to analysis the accuracy rate. Cardiologists' operation information were used to find risk factors of misjudgment by single-factor analysis.
The mean SS of 528 patients was 13.4 ± 0.8. The total accuracy rate was 59.3%, 12.3% was underestimated and 28.4% was overestimated. The accuracy rate varied significantly from 0% to 75% between different cardiologists. According to groups divided by subjective judgment, the accuracy rate was respectively 82.2% in the low-risk group, 14.3% (1.9%, underestimated; 83.8%, overestimated) in intermediate-risk group, 10.1% in the high-risk group. Compared with low-risk lesions, the misjudgment increased significantly by the severity of lesions in both intermediate (OR=8.6, [4.7-15.6]) and high-risk (OR=5.8, [2.4-14.1]) lesions group. No relationship was found according to cardiologists' operation amount per year (Pearson r=0.16, p=0.70) and operation difficulty (Pearson r=-0.072, p=0.83).
Subjective SS category assessment was not accurate enough in the real world in China, especially in complex lesions. Cardiologists were more likely to overestimate the severity of lesions in China.