title: Inter- and intra-observer variability for assessment of the synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) score and association of the SYNTAX score with clinical outcome in patients undergoing unprotected left main stenting in the real world.
abstract: BACKGROUND
  The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) score was proposed as a method to evaluate the complexity of coronary anatomy. However, the reproducibility of assessment for the SYNTAX score in unprotected left main coronary artery (ULMCA) disease has not yet been adequately evaluated. The purpose of this study is to assess inter- and intra-observer variability for the assessment of the SYNTAX score in patients undergoing ULMCA stenting in daily clinical practice.
  
  
  RESULTS
  The SYNTAX score of 101 consecutive patients who underwent ULMCA stenting with sirolimus-eluting stent was independently assessed by 2 experienced interventional cardiologists. One of the 2 cardiologists evaluated all the cases again 6 months after the initial assessment. The κ value for inter-observer variability in estimating the SYNTAX score was 0.62 according to the dichotomized analysis (≥ 33, < 33) and 0.58 according to the tertile analysis (< 23, 23 ≤ - < 33, ≥ 33), while the intra-observer variability was 0.78 and 0.69, respectively. Patients with a high SYNTAX score (≥ 33, n = 55) compared with those with low or intermediate score (< 33, n = 46) had a significantly higher rate of target-lesion revascularization (TLR) of the ULMCA lesion at 2 years (24% vs. 4.4%, P = 0.01).
  
  
  CONCLUSIONS
  Both inter- and intra-observer variability for estimating the SYNTAX score were within an acceptable range and a high SYNTAX score showed a higher rate of TLR in patients undergoing ULMCA stenting in daily clinical practice.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tamura
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Niki
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Tada
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.forename: Masanao
authors.initials: M
authors.lastname: Toma
authors.forename: Koh
authors.initials: K
authors.lastname: Ono
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shioi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Masaharu
authors.initials: M
authors.lastname: Akao
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006348:Cardiac Surgical Procedures / Q000592:standards; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009204:Myocardial Revascularization; D015588:Observer Variation; D011379:Prognosis; D012720:Severity of Illness Index; D013223:Statistics as Topic; D015607:Stents; D016896:Treatment Outcome