Abstract 8596: Reproducibilty of the Syntax Score (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) in a Real World Setting: Implications for the Choice of Contemporary Revascularisation Strategy
INTRODUCTION: The two year results from the Syntax study indicate that percutaneous coronary intervention (PCI) may be an acceptable alternative to CABG in subjects with a low (<22) and intermediate (23-32) Syntax Score (SS). Patients with high SS (≥33) appear to have worse outcome from PCI. It has been suggested that CABG should remain the treatment in this cohort. The Syntax investigators report good reproducibility for the SS; however, the inter and intra operator variability has not been tested outside the core lab environment. This is pertinent as more cardiac multidisciplinary meetings (MDT) are using the SS to help guide revascularization strategy.
METHODS: 20 patients presented at our MDT were randomly selected and 11 cardiologists of differing experience independently scored these angiograms on two separate occasions, after completing the teaching module at www.syntaxscore.com.
RESULTS: There was wide variation in SS for each angiogram with 8.4±1.3 min required per SS (Figure). Moreover, variation did not conform over the two sittings to operator experience or to lesion complexity (Mean Difference between scores per operator 9±4). The total mean scores from all operators were taken as a gold standard result with respect to tertile allocation. Operators allocated 50% of patients to a different tertile, with only 2 patients placed by all operators in the same tertile of risk. Additionally, at the second sitting the same operators cast the same angiogram into a different tertile of risk from their original assessment on 46% of occasions.
CONCLUSION: Syntax scoring in a real world MDT setting was not reproducible and demonstrated significant intra and inter operator variability between subjects. MDT discussions incorporating this score should be aware of this and weigh the significance of the score accordingly when forming decisions about revascularization strategy.
- © 2011 by American Heart Association, Inc.