Is the SYNTAX score a predictor of long-term outcome after coronary artery bypass surgery?
BACKGROUND
The SYNTAX score was introduced to measure the complexity of coronary artery disease. Although a high SYNTAX score is indicative of a worse long-term outcome after percutaneous coronary intervention (PCI), it remains unclear whether it is also true for coronary artery bypass grafting (CABG).


METHODS
We analyzed 200 consecutive CABG patients who underwent operations in 2002. Demographic and intraoperative data, perioperative outcomes, and 5-year outcomes were obtained. The SYNTAX score was calculated retrospectively by reviewing the original diagnostic angiograms. After excluding patients who had undergone CABG or PCI treatment within 6 months before surgery, we included 154 patients in the study. Patients were partitioned into tertiles according to the SYNTAX score (low, < or =18; intermediate, >18-26; high, >26). Cox regression analysis was used to identify baseline and procedural predictors for the combined end point of 5-year major adverse cardiac and cerebrovascular events (MACCE) and its components. Cumulative event rates were estimated by Kaplan-Meier methods.


RESULTS
The mean (+/-SD) age was 66.6 +/- 8.5 years, the mean ejection fraction was 56.4% +/- 13.6%, and the mean logistic EuroSCORE was 4.2% +/- 4.7%. The SYNTAX score ranged between 2 and 52. The overall survival rate was 94.8% at 1 year and 84.1% at 5 years. The rate of freedom from MACCE was 92.9% and 78.0% at 1 and 5 years, respectively. Only a higher EuroSCORE, a New York Heart Association class of III to IV, and smoking could be identified with Cox regression as risk factors for MACCE during follow-up. The overall survival and MACCE rates of the 3 SYNTAX score subgroups were not significantly different.


CONCLUSIONS
Complex coronary pathology as measured by the SYNTAX score did not affect the long-term outcome after CABG in this study.
Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. dholzhey@web.de
David M
DM
Holzhey
Martin M
MM
Luduena
Ardawan
A
Rastan
Stephan
S
Jacobs
Thomas
T
Walther
Friedrich W
FW
Mohr
Volkmar
V
Falk
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016001:Confidence Intervals; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D005260:Female; D005858:Germany; D006305:Health Status Indicators; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013318:Stroke Volume; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left