Assessment of the SYNTAX score in the Syntax study.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Surgery

Background:

• The SYNTAX score was developed to evaluate risks associated with percutaneous or surgical revascularization.
• It considers anatomical factors like bifurcations, occlusions, thrombus, calcification, and small vessels to assess functional impact.
• Complex coronary artery disease necessitates accurate risk stratification tools.

Purpose of the Study:

• To describe the baseline assessment of the SYNTAX score in the Syntax randomized trial.
• To evaluate core laboratory reproducibility and inter-observer variability.
• To ascertain the impact of the SYNTAX score on one-year outcomes after PCI or CABG.

Main Methods:

• 100 diagnostic angiograms from the Syntax trial were independently assessed by two observers for reliability.
• Intra-observer variability was assessed using 91 angiograms after an eight-week interval.
• Clinical outcomes up to one year were analyzed, stratified by SYNTAX score tertiles.

Main Results:

• Inter-observer reproducibility (weighted kappa) was 0.45; intra-observer reproducibility was 0.59.
• Investigators' SYNTAX scores were consistently lower than core laboratory scores by 3.4 points.
• Higher SYNTAX scores were associated with increased Major Adverse Cardiac and Cerebrovascular Events (MACCE) rates in the PCI group compared to CABG.

Conclusions:

• The SYNTAX score demonstrates acceptable core laboratory reproducibility.
• The score impacts one-year outcomes for patients undergoing PCI but not for those undergoing CABG.
• The SYNTAX score is a valuable tool for managing patients with complex coronary artery disease.