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

Davide Capodanno, MD^_*,,_*, Piera Capranzano, MD^_*,, Maria Elena Di Salvo, MD^_*, Anna Caggegi, MD^_*, Davide Tomasello, MD^_*,, Glauco Cincotta, MD^_*, Marco Miano, MD^_*, Martina Patané, MD^_*, Claudia Tamburino, MD^_*, Salvatore Tolaro, MD, Leonardo Patané, MD^||, Antonio Maria Calafiore, MD, Corrado Tamburino, MD^_*,

^_* Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
Department of Cardiac Surgery, Ferrarotto Hospital, University of Catania, Catania, Italy
ETNA Foundation, Catania, Italy
Morgagni Heart Center, Cardiac Catheterization Laboratory, Pedara, Italy
^|| Morgagni Heart Center, Cardiac Surgery, Pedara, Italy

^_* Reprint requests and correspondence: Dr. Davide Capodanno, Department of Cardiology, Ferrarotto Hospital, University of Catania, via Citelli 6, 95124 Catania, Italy (Email: dcapodanno{at}gmail.com).

Objectives: The purpose of our study was to investigate the utility of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) score in aiding patient selection for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in a large contemporary registry of patients undergoing revascularization of left main coronary artery.

Background: The SYNTAX score has been developed as a combination of several validated angiographic classifications aiming to grade the coronary lesions with respect to their functional impact, location, and complexity.

Methods: Between March 2002 and December 2008, 819 patients with left main coronary artery disease underwent revascularization in 2 Italian centers. We compared clinical outcomes of PCI versus CABG in patients with SYNTAX score 34 and patients with SYNTAX score >34.

Results: The rates of 2-year mortality were similar between CABG and PCI in the group of patients with SYNTAX score 34 (6.2% vs. 8.1%, p = 0.461). Among patients with SYNTAX score >34, those treated with CABG had lower rates of mortality (8.5% vs. 32.7%, p < 0.001) than those treated with PCI. After statistical adjustment, revascularization by PCI resulted in a similar risk of death compared with CABG in patients with SYNTAX score 34 (hazard ratio: 0.81, 95% confidence interval: 0.33 to 1.99, p = 0.64) and in a significantly higher risk in patients with SYNTAX score >34 (hazard ratio: 2.54, 95% confidence interval: 1.09 to 5.92, p = 0.031).

Conclusions: A SYNTAX score threshold of 34 may usefully identify a cohort of patients with left main disease who benefit most from surgical revascularization in terms of mortality.

Key Words: unprotected left main • percutaneous coronary intervention • coronary artery bypass graft

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CAD = coronary artery disease   CI = confidence interval   DES = drug-eluting stent(s)   HR = hazard ratio   PCI = percutaneous coronary intervention   ULMCA = unprotected left main coronary artery