Key result
Percutaneous coronary intervention in patients with a low SYNTAX score resulted in a similar mortality rate compared to coronary artery bypass surgery in patients with a high SYNTAX score (OR 1.17).
Why the study?
Does PCI or CABG with a low SYNTAX score improve clinical outcomes compared to a high SYNTAX score in patients undergoing revascularization?
Meta-Analysis (n=11,037)
Does PCI or CABG with a low SYNTAX score improve clinical outcomes compared to a high SYNTAX score in patients undergoing revascularization?
A low SYNTAX score is associated with significantly lower adverse outcomes compared to a high SYNTAX score following PCI or CABG, while PCI with a low score has comparable mortality to CABG with a high score.
Answers are grounded in this paper and cite their sources.
Similar mortality supports SYNTAX-guided risk stratification in revascularization; leaves open direct PCI-CABG comparisons in score-matched cohorts.
The SYNTAX [Synergy Between percutaneous coronary intervention (PCI) With Taxus and coronary artery bypass surgery (CABG)] score is a decision-making tool in interventional cardiology. However, several facts still remain to be addressed: What about PCI or CABG with a low versus a high score respectively? And what about PCI with a low score versus CABG with a high score? Electronic databases were carefully searched for relevant publications. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated and the analysis was carried out by RevMan 5.3. Eleven studies with a total number of 11,037 patients were included. In terms of clinical outcomes, this analysis showed PCI to have significantly favored patients with a low versus a high SYNTAX score. In patients who were re-vascularized by CABG, mortality and major adverse cardiac events were significantly lower with a low SYNTAX score. However, when PCI with a low SYNTAX score was compared with CABG with a high SYNTAX score, no significant difference in mortality and combined death/stroke/myocardial infarction were observed. In conclusion, the SYNTAX score might be considered useful in interventional cardiology. Nevertheless, the fact that it has limitations when compared to newer tools should also not be ignored.
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Bundhun et al. (2017) conducted a meta-analysis in Coronary artery disease (n=11,037). Percutaneous coronary intervention (PCI) with a low SYNTAX score vs. Coronary artery bypass surgery (CABG) with a high SYNTAX score was evaluated on Mortality (OR 1.17, 95% CI 0.61-2.23, p=0.64). Percutaneous coronary intervention in patients with a low SYNTAX score resulted in a similar mortality rate compared to coronary artery bypass surgery in patients with a high SYNTAX score (OR 1.17).
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