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The SYNTAX score (SS) was developed to create an objective angiographic measure to assign patients with left main (LM) or triple vessel (3VD) coronary artery disease to either percutaneous coronary interventions (PCI) or coronary artery bypass graft (CABG) surgery. To date, there is no data as to the extent of the SS use in ‘real life’ practice.
To assess the adequacy of the decision making process in our institution, we studied 290 consecutive patients who underwent coronary angiography from 1/1/2009 to 31/12/2010 with LM/3VD diagnosis and who were referred to either CABG (n=140) or PCI (n=150). Each case was reviewed and the SS was calculated. We compared the actual referral statistics for CABG vs. PCI according to SS values and adherence to the guidelines. We also collected clinical outcomes at 1 year according to interactions between SS and treatment.
The baseline clinical and angiographic characteristics were similar between the two groups. The average SS was higher in the group assigned to CABG (23.8 vs. 19.0, p<0.001). In 65% of the cases, there was an agreement between the clinical decision and the SS as to the preferred mode of revascularization. Analyzing by revascularization technique showed a 78% agreement in the patients assigned to PCI and only 51% agreement in those assigned to CABG. Analyzing by coronary anatomy showed a 69% agreement in the patients with 3VD and only 51% agreement with LM disease. The clinical judgment of the cardiologist has a sensitivity of 0.69 (95% CI 0.59–0.78) and specificity of 0.63 (CI 0.55–0.7) for accurately assigning patients for surgical revascularization and the PPV was 0.50 (CI 0.42–0.59) and NPV was 0.79 (CI 0.71–0.85). No differences in clinical outcomes were found between the subgroups distinguished by SS and/or mode of treatment at one year.
There was a considerable disagreement between the clinical decision and measured SS concerning the actual mode of revascularization in patients with LM/3VD. At one year follow up, the clinical outcome was similar regardless of the SS and/or mode of revascularization.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Multivessel Disease
Abstract Category: 45. TCT@ACC–i2: Coronary Intervention, Multivessel disease
Presentation Number: 2104–264
- 2013 American College of Cardiology Foundation