title: Long-term outcomes of patients with complex coronary artery disease according to agreement between the SYNTAX score and revascularization procedure in contemporary practice.
abstract: OBJECTIVE
  The SYNTAX score (SS) has been shown to identify subgroups of patients with left main or triple-vessel coronary artery disease (LM/3VCAD) that can be treated with a percutaneous coronary intervention (PCI) with equal clinical outcomes as coronary artery bypass surgery (CABG).We sought to assess the adequacy of referral to PCI/CABG of patients with LM/3VCAD at our institution.
  
  
  METHODS
  We retrospectively matched all patients with LM/3VCAD referred to CABG (n=145) to patients referred to PCI in our institution during 2009-2010. We calculated the SS and clinical SS (cSS) according to the European Society of Cardiology guidelines and compared the agreement rates between the revascularization modality and the SS as well as clinical outcomes at the 3-year follow-up.
  
  
  RESULTS
  The overall agreement rates between the revascularization procedure and the SS was 67%, for example the rate was higher in patients referred to PCI compared with CABG (78 vs. 49%) and patients with 3VCAD compared with patients with LMCAD (68 vs. 51%). Patients without agreement between the revascularization modality and the SS had higher rates of combined adverse cardiac events (42.6 vs. 27% P=0.008). Similar results were observed when using the cSS at different cutoff levels.
  
  
  CONCLUSIONS
  At our institution, there was considerable disagreement between a clinical judgment-based coronary revascularization and the SS/cSS-based allocation process as to the preferred revascularization modality for patients with complex CAD. Our results suggest that integrating the SS/cSS into the decision-making process for assigning patients to revascularization would yield better clinical outcomes.
authors.affiliation: aDepartment of Cardiology, Rabin Medical Center, Petach Tikva bSackler School of Medicine, Tel Aviv University, Tel Aviv.
authors.forename: Guy
authors.initials: G
authors.lastname: Witberg
authors.forename: Ifat
authors.initials: I
authors.lastname: Lavi
authors.forename: Ophir
authors.initials: O
authors.lastname: Gonen
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Eli
authors.initials: E
authors.lastname: Lev
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome