Patients with a high SYNTAX score (≥33) undergoing unprotected left main coronary artery stenting had a significantly higher rate of target-lesion revascularization at 2 years compared to those with a lower score (24% vs. 4.4%, P=0.01).
Observational (n=101)
Observers blinded to procedural results and clinical outcomes
No
Does the SYNTAX score have acceptable reproducibility and predict clinical outcomes in patients undergoing unprotected left main coronary artery stenting in real-world practice?
The SYNTAX score demonstrates acceptable inter- and intra-observer reproducibility in real-world ULMCA stenting, and a score ≥33 is associated with a significantly higher risk of target lesion revascularization at 2 years.
Absolute Event Rate: 24% vs 4.4%
p-value: p=0.01
BACKGROUND: The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) score was proposed as a method to evaluate the complexity of coronary anatomy. However, the reproducibility of assessment for the SYNTAX score in unprotected left main coronary artery (ULMCA) disease has not yet been adequately evaluated. The purpose of this study is to assess inter- and intra-observer variability for the assessment of the SYNTAX score in patients undergoing ULMCA stenting in daily clinical practice. METHODS AND RESULTS: The SYNTAX score of 101 consecutive patients who underwent ULMCA stenting with sirolimus-eluting stent was independently assessed by 2 experienced interventional cardiologists. One of the 2 cardiologists evaluated all the cases again 6 months after the initial assessment. The κ value for inter-observer variability in estimating the SYNTAX score was 0.62 according to the dichotomized analysis (≥ 33, < 33) and 0.58 according to the tertile analysis (< 23, 23 ≤ - < 33, ≥ 33), while the intra-observer variability was 0.78 and 0.69, respectively. Patients with a high SYNTAX score (≥ 33, n = 55) compared with those with low or intermediate score (< 33, n = 46) had a significantly higher rate of target-lesion revascularization (TLR) of the ULMCA lesion at 2 years (24% vs. 4.4%, P = 0.01). CONCLUSIONS: Both inter- and intra-observer variability for estimating the SYNTAX score were within an acceptable range and a high SYNTAX score showed a higher rate of TLR in patients undergoing ULMCA stenting in daily clinical practice.
Shiomi et al. (Sat,) conducted a observational in Unprotected left main coronary artery (ULMCA) disease (n=101). High SYNTAX score (≥33) vs. Low-intermediate SYNTAX score (<33) was evaluated on Target-lesion revascularization (TLR) at 2 years (p=0.01). Patients with a high SYNTAX score (≥33) undergoing unprotected left main coronary artery stenting had a significantly higher rate of target-lesion revascularization at 2 years compared to those with a lower score (24% vs. 4.4%, P=0.01).