January 1, 2020Therapeutic Advances in Cardiovascular DiseaseOpen Access

Inter-observer variation of Syntax score among cardiac surgeons, clinical and interventional cardiologists

View Full Paper

Ask AI

Bookmark

Why the study?

Despite the complexity of the SYNTAX score, guidelines recommend it to guide revascularization, but inter-observer variation across different specialties required evaluation.

Does the SYNTAX score calculation vary significantly among clinical cardiologists, interventional cardiologists, and cardiac surgeons?

Structured PICO

Does the SYNTAX score calculation vary significantly among clinical cardiologists, interventional cardiologists, and cardiac surgeons?

Population

30 observers (10 clinical cardiologists, 10 interventional cardiologists, and 10 cardiac surgeons) evaluating 7 coronary angiographies from patients with left main and/or three-vessel disease.

Intervention

SYNTAX score calculation via SYNTAX website

Comparator

Comparison among clinical cardiologists, interventional cardiologists, and cardiac surgeons

Outcome

Inter-observer variation (Kappa concordance) of the SYNTAX score

There is significant inter-observer variability in SYNTAX score calculation among different cardiovascular specialists, highlighting the need for specific training to avoid misclassification of borderline cases.

Implication

Variability in SYNTAX scoring may influence revascularization choices; leaves open whether training or automation improves consistency.

Abstract

Background: Despite the complexity of SYNTAX score (SS), guidelines recommend this tool to help choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with left main of three-vessel coronary artery disease. The aim of this study was to compare the inter-observer variation in SS performed by clinical cardiologists (CC), interventional cardiologists (IC), and cardiac surgeons (CS). Methods: Seven coronary angiographies from patients with left main and/or three-vessel disease chosen by a heart team were analyzed by 10 CC, 10 IC and 10 CS. SS was calculated via SYNTAX website. Results: Kappa concordance was very low between CC and CS (k = 0.176), moderate between CS and IC (k = 0.563), and moderate between CC and IC (0.553). There was a statistically significant difference between CC, who classified more cases as low complexity (70%), and CS, who classified more cases as moderate complexity (80%) ( p = 0.041). Conclusion: Concordance between SS analyzed by CC, CS and IC is low. The usefulness of SS in decision-making of revascularization strategy is undeniable and evidence supports its use. However, this study highlights the importance of well-trained professionals on calculating the SS. It could avoid misclassification of borderline cases.