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
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Figure 1 Unadjusted 2-Year Incidence of Mortality Stratified by the SYNTAX Score
Unadjusted 2-year cumulative incidence of mortality between patients treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) stratified according to a SYNTAX score lower (left) or higher (right) than 34. No significant differences in terms of mortality are apparent between PCI and CABG in the subgroup of patients with SYNTAX score  34. Conversely, CABG represents the best revascularization option in patients with SYNTAX score >34.
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Figure 2 Unadjusted and Adjusted 2-Year RR of Death With PCI or CABG Among Patients Stratified According to a SYNTAX Score Threshold of 34
Adjustment for unbalanced characteristics between patients treated with PCI and those treated with CABG stratified by SYNTAX score corroborates the understanding that a threshold of 34 is effective in aiding clinical decision making and patient selection for surgery. CI = confidence interval; HR = hazard ratio; RR = relative risk; other abbreviations as in Figure 1.
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Figure 3 Differences of Complete Revascularization Rates According to a SYNTAX Score Threshold of 34 Between Patients Treated With PCI or CABG
Complete revascularization is highly dependent by SYNTAX score in patients treated with PCI. Patients with multiple lesions and higher SYNTAX score are more likely to achieve the goal of complete revascularization if they are treated with CABG. This may explain differences in outcomes between revascularization strategies in patients with SYNTAX score >34. Abbreviations as in Figure 1.
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