Assessment of the SYNTAX score in the Syntax study.
OBJECTIVE
The SYNTAX score has been designed to better anticipate the risks of percutaneous or surgical revascularisation, taking into account the functional impact of the coronary circulation with all its anatomic components including the presence of bifurcations, total occlusions, thrombus, calcification, and small vessels. The purpose of this paper is to describe the baseline assessment of the SYNTAX score in the Syntax randomised trial, the corelab reproducibility, the potential difference in score assessment between the investigator and the corelab, and to ascertain the impact on one-year outcome after either percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) in patients with complex coronary artery disease.


RESULTS
To assess the reliability of Syntax scoring, 100 diagnostic angiograms from the Syntax trial were randomly selected and assessed independently by two observers. Intra-observer variability was assessed by analysing 91 sets of angiograms after an interval of at least eight weeks by one of the observers. Clinical outcomes in the randomised cohort of the Syntax trial up to one year are presented with stratification by tertile group of the SYNTAX score. The weighted kappa value for the inter-observer reproducibility on the global score was 0.45, while the intra-observer weighted kappa value was 0.59. The SYNTAX score as calculated by investigators consistently underscored the corelab score by 3.4 points. When the Syntax randomised cohort was stratified by tertiles of the SYNTAX score, there were similar or non-significantly different MACCE rates in those with low or intermediate scores; however in the top tertile the MACCE rate was greater in those receiving PCI compared to CABG.


CONCLUSIONS
The SYNTAX score is a visual coronary score with an acceptable corelab reproducibility that has an impact on the one-year outcome of those having PCI, whereas it has no effect on the one-year outcome following surgical revascularisation. The SYNTAX score tool is likely to be useful in a wide range of patients with complex coronary disease.
Serruys
Patrick W
PW
Department of Interventional Cardiology, Erasmus Medical Center, Thoraxcenter Rotterdam, The Netherlands. p.w.j.c.serruys@erasmusmc.nl
Onuma
Yoshinobu
Y
Garg
Scot
S
Sarno
Giovanna
G
van den Brand
Marcel
M
Kappetein
Arie-Pieter
AP
Van Dyck
Nic
N
Mack
Michael
M
Holmes
David
D
Feldman
Ted
T
Morice
Marie-Claude
MC
Colombo
Antonio
A
Bass
Eric
E
Leadley
Katrin
K
Dawkins
Keith D
KD
van Es
Gerrit-Anne
GA
Morel
Marie-Angèle M
MA
Mohr
Friedrich W
FW
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*; D005060:Europe; D006801:Humans; D015337:Multicenter Studies as Topic; D015588:Observer Variation; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States