Key result
SYNTAX Score II 2020 predicts 5-year mortality and identifies patients with survival benefit from CABG.
Why the study?
The SYNTAX score II 2020 was derived and validated in randomized trials but its value in identifying the safest revascularization modality in a non-randomized setting was unknown.
Does the SYNTAX score II 2020 (SSII-2020) accurately predict 5-year mortality and MACE to identify the safest modality of revascularization (PCI vs CABG) in patients with 3VD and/or LMCAD?
Observational (n=7,362)
Does the SYNTAX score II 2020 (SSII-2020) accurately predict 5-year mortality and MACE to identify the safest modality of revascularization (PCI vs CABG) in patients with 3VD and/or LMCAD?
Answers are grounded in this paper and cite their sources.
External validation in a Japanese registry confirms the SYNTAX Score II 2020 accurately predicts 5-year mortality and can aid in identifying which patients with complex coronary disease derive a clear survival benefit from CABG over PCI.
BACKGROUND The SYNTAX score II 2020 (SSII-2020) was derived from cross correlation and externally validated in randomized trials to predict death and major adverse cardiac and cerebrovascular events (MACE) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with 3-vessel disease (3VD) and/or left main coronary artery disease (LMCAD). OBJECTIVES The authors aimed to investigate the SSII-2020's value in identifying the safest modality of revascularization in a non-randomized setting. METHODS Five-year mortality and MACE were assessed in 7,362 patients with 3VD and/or LMCAD enrolled in a Japanese PCI/CABG registry. The discriminative abilities of the SSII-2020 were assessed using Harrell's C statistic. Agreement between observed and predicted event rates following PCI or CABG and treatment benefit (absolute risk difference [ARD]) for these outcomes were assessed by calibration plots. RESULTS The SSII-2020 for 5-year mortality well predicted the prognosis after PCI and CABG (C-index = 0.72, intercept = -0.11, slope = 0.92). When patients were grouped according to the predicted 5-year mortality ARD, <4.5% (equipoise of PCI and CABG) and ≥4.5% (CABG better), the observed mortality rates after PCI and CABG were not significantly different in patients with lower predicted ARD (observed ARD: 2.1% [95% CI: -0.4% to 4.4%]), and the significant difference in survival in favor of CABG was observed in patients with higher predicted ARD (observed ARD: 9.7% [95% CI: 6.1%-13.3%]). For MACE, the SSII-2020 could not recommend a specific treatment with sufficient accuracy. CONCLUSIONS The SSII-2020 for predicting 5-year death has the potential to support decision making on revascularization in patients with 3VD and/or LMCAD.
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Hara et al. (2021) conducted an observational in 3-vessel disease and/or left main coronary artery disease (n=7,362). SYNTAX Score II 2020 (SSII-2020) was evaluated on 5-year mortality (C-index 0.72). The SYNTAX Score II 2020 well predicted 5-year mortality after revascularization (C-index 0.72) and identified a significant survival benefit for CABG in patients with a predicted absolute risk difference ≥4.5%.
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