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SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial

Rodrigo B Esper1, Michael E Farkouh2, Expedito E Ribeiro3

  • 1Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil; Prevent Senior Institute, São Paulo, Brazil.

Journal of the American College of Cardiology
|December 8, 2018
PubMed

Insights

The SYNTAX score predicts cardiovascular events in diabetes patients with complex coronary artery disease undergoing percutaneous coronary intervention, but not coronary artery bypass grafting. This score should not guide revascularization choices in this patient group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diabetology

Background:

  • Diabetes mellitus (DM) is linked to complex coronary artery disease (CAD), increasing cardiovascular disease morbidity and mortality.
  • Evaluating risk stratification tools is crucial for managing patients with DM and complex CAD.

Purpose of the Study:

  • To assess the SYNTAX score's (SS) predictive value for cardiovascular events in patients with DM and complex CAD.
  • To compare the efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in this patient population using the SS.

Main Methods:

  • The FREEDOM trial randomized 1,900 patients with DM and multivessel CAD to either PCI with drug-eluting stents or CABG.
  • The SYNTAX score was retrospectively calculated to evaluate coronary complexity.
  • Hard cardiovascular events (HCE) and major adverse cardiac and cerebrovascular events (MACCE) were tracked over 5 years.

Main Results:

  • The SS independently predicted 5-year MACCE and HCE in the PCI cohort, but not in the CABG cohort.
  • Patients undergoing PCI experienced higher rates of MACCE across all SS strata (low, intermediate, high) compared to those treated with CABG.

Conclusions:

  • In patients with DM and multivessel CAD, the SS is an independent risk factor for MACCE and HCE exclusively in those treated with PCI.
  • The SYNTAX score should not be used to guide the selection of coronary revascularization strategy in patients with DM and complex CAD.
Abstract

Keywords:
CABGPCISYNTAX scorecoronary artery diseasediabetes

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