title: SYNTAX Score and Long-Term Outcomes: The BARI-2D Trial.
abstract: BACKGROUND
  The extent of coronary disease affects clinical outcomes and may predict the effectiveness of coronary revascularization with either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score quantifies the extent of coronary disease.
  
  
  OBJECTIVE
  This study sought to determine whether SYNTAX scores predicted outcomes and the effectiveness of coronary revascularization compared with medical therapy in the BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial.
  
  
  METHODS
  Baseline SYNTAX scores were retrospectively calculated for BARI-2D patients without prior revascularization (N = 1,550) by angiographic laboratory investigators masked to patient characteristics and outcomes. The primary outcome was major cardiovascular events (a composite of death, myocardial infarction, and stroke) over 5 years.
  
  
  RESULTS
  A mid/high SYNTAX score (≥23) was associated with a higher risk of major cardiovascular events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01). Patients in the CABG stratum had significantly higher SYNTAX scores: 36% had mid/high SYNTAX scores compared with 13% in the PCI stratum (p < 0.001). Among patients with low SYNTAX scores (≤22), major cardiovascular events did not differ significantly between revascularization and medical therapy, either in the CABG stratum (26.1% vs. 29.9%, p = 0.41) or in the PCI stratum (17.8% vs. 19.2%, p = 0.84). Among patients with mid/high SYNTAX scores, however, major cardiovascular events were lower after revascularization than with medical therapy in the CABG stratum (15.3% vs. 30.3%, p = 0.02), but not in the PCI stratum (35.6% vs. 26.5%, p = 0.12).
  
  
  CONCLUSIONS
  Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305).
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: fikeno@stanford.edu.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Ikeno
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Maria Mori
authors.initials: MM
authors.lastname: Brooks
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Kaori
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Min-Kyu
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kaneda
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mitsutake
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Vlachos
authors.affiliation: Division of Cardiology, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Leonard
authors.initials: L
authors.lastname: Schwartz
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Frye
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Waseda
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D048909:Diabetes Complications / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012107:Research Design; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: angiography; coronary disease; ischemia; prognosis; stents; surgery