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External Validation of the SYNTAX Score II 2020

Hironori Hara1, Hiroki Shiomi2, David van Klaveren3

  • 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Journal of the American College of Cardiology
|September 17, 2021
PubMed

Insights

The SYNTAX score II 2020 accurately predicts 5-year mortality after coronary revascularization in patients with complex coronary artery disease. It helps guide decisions between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • The SYNTAX score II 2020 (SSII-2020) is a validated tool for predicting outcomes after revascularization.
  • It assesses risks for death and major adverse cardiac and cerebrovascular events (MACE) following PCI and CABG in patients with 3-vessel disease (3VD) and/or left main coronary artery disease (LMCAD).

Purpose of the Study:

  • To evaluate the SSII-2020's effectiveness in determining the optimal revascularization strategy (PCI vs. CABG) in a real-world, non-randomized setting.
  • To assess the score's ability to predict long-term mortality and MACE in a large patient cohort.

Main Methods:

  • Analysis of 7,362 patients with 3VD and/or LMCAD from a Japanese PCI/CABG registry.
  • Assessment of 5-year mortality and MACE using the SSII-2020.
  • Statistical evaluation included Harrell's C statistic for discrimination and calibration plots for agreement between predicted and observed outcomes.

Main Results:

  • The SSII-2020 demonstrated good predictive accuracy for 5-year mortality post-PCI and CABG (C-index = 0.72).
  • Patients stratified by predicted mortality risk showed no significant difference in observed mortality between PCI and CABG for lower risk (<4.5%), but CABG was superior for higher risk (≥4.5%).
  • The SSII-2020's accuracy in recommending treatment for MACE was insufficient.

Conclusions:

  • The SSII-2020 shows potential as a decision-making tool for revascularization strategies in patients with 3VD and/or LMCAD, particularly for predicting mortality.
  • Further refinement may be needed for its application in guiding treatment decisions for MACE.
Abstract

Keywords:
CABGPCIpredictive model

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