title: The CABG SYNTAX Score - an angiographic tool to grade the complexity of coronary disease following coronary artery bypass graft surgery: from the SYNTAX Left Main Angiographic (SYNTAX-LE MANS) substudy.
abstract: OBJECTIVE
  The SYNTAX Score (SXscore) has established itself as an important prognostic tool in patients undergoing percutaneous coronary intervention (PCI). A limitation of the SXscore is the inability to differentiate outcomes in patients who have undergone prior coronary artery bypass graft (CABG) surgery. The CABG SXscore was devised to address this limitation.
  
  
  RESULTS
  In the SYNTAX-LE MANS substudy 115 patients with unprotected left main coronary artery disease (isolated or associated with one, two or three-vessel disease) treated with CABG were prospectively assigned to undergo a 15-month coronary angiogram. An independent core laboratory analysed the baseline SXscore prior to CABG. The 15-month CABG SXscore was calculated by a panel of three interventional cardiologists. The CABG SXscore was calculated by determining the standard SXscore in the "native" coronary vessels ("native SXscore") and deducting points based on the importance of the diseased coronary artery segment (Leaman score) that have a functioning bypass graft anastomosed distally. Points relating to intrinsic coronary disease, such as bifurcation disease or calcification, remain unaltered. The mean 15-month CABG SXscore was significantly lower compared to the mean baseline SXscore (baseline SXscore 31.6, SD 13.1; 15-month CABG SXscore 21.2, SD 11.1; p<0.001). Reproducibility analyses (kappa [k] statistics) indicated a substantial agreement between CABG SXscore measurements (k=0.70; 95% CI [0.50-0.90], p<0.001), with the points deducted to calculate the CABG SXscore the most reproducible measurement (k=0.74; 95% CI [0.53-0.95], p<0.001). Despite the limited power of the study, four-year outcome data (Kaplan-Meier curves) demonstrated a trend towards reduced all-cause death (9.1% vs. 1.8%, p=0.084) and death/CVA/MI (16.4% vs. 7.0%, p=0.126) in the low compared to the high CABG SXscore group.
  
  
  CONCLUSIONS
  In this pilot study the calculation of the CABG SXscore appeared feasible, reproducible and may have a long-term prognostic role in patients with complex coronary disease undergoing surgical revascularisation. Validation of this new scoring methodology is required.
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands.
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.forename: Chrysafios
authors.initials: C
authors.lastname: Girasis
authors.forename: Michael
authors.initials: M
authors.lastname: Magro
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Marie Angèle
authors.initials: MA
authors.lastname: Morel
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Heo
authors.forename: Hector
authors.initials: H
authors.lastname: Garcia-Garcia
authors.forename: Arie Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Marcel
authors.initials: M
authors.lastname: van den Brand
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ståhle
authors.forename: Stefan
authors.initials: S
authors.lastname: James
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Gerard
authors.initials: G
authors.lastname: Fournial
authors.forename: Gerrit-Anne
authors.initials: GA
authors.lastname: van Es
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery*; D003661:Decision Support Techniques; D005240:Feasibility Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D009203:Myocardial Infarction / Q000209:etiology; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome