title: Assessment of the SYNTAX score in the Syntax study.
abstract: 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.
authors: Department of Interventional Cardiology, Erasmus Medical Center, Thoraxcenter Rotterdam, The Netherlands. p.w.j.c.serruys@erasmusmc.nl
authors: Patrick W
authors: PW
authors: Serruys
authors: Yoshinobu
authors: Y
authors: Onuma
authors: Scot
authors: S
authors: Garg
authors: Giovanna
authors: G
authors: Sarno
authors: Marcel
authors: M
authors: van den Brand
authors: Arie-Pieter
authors: AP
authors: Kappetein
authors: Nic
authors: N
authors: Van Dyck
authors: Michael
authors: M
authors: Mack
authors: David
authors: D
authors: Holmes
authors: Ted
authors: T
authors: Feldman
authors: Marie-Claude
authors: MC
authors: Morice
authors: Antonio
authors: A
authors: Colombo
authors: Eric
authors: E
authors: Bass
authors: Katrin
authors: K
authors: Leadley
authors: Keith D
authors: KD
authors: Dawkins
authors: Gerrit-Anne
authors: GA
authors: van Es
authors: Marie-Angèle M
authors: MA
authors: Morel
authors: Friedrich W
authors: FW
authors: Mohr
mesh_terms: 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