Abstract 16176: SYNTAX Score and Clinical SYNTAX Score Predict Outcomes of Patients Undergoing Coronary Artery Bypass Grafting
The newly developed SYNTAX score (SS) to measure coronary artery disease complexity has been shown to be a determinant of outcome in patients undergoing percutaneous coronary intervention. Adding clinical variables to SS improves the predictive power of the resulting risk model. We assessed the hypothesis that the use of SYNTAX score and Clinical SYNTAX score (ClinSS) may predict outcomes of patients amenable to surgical revascularization for ischemic heart disease.
For this aim, a consecutive series of 874 patients (mean age ± SEM: 68±3 years; male gender 79%) undergoing isolated first-time coronary artery bypass graft surgery was studied. The SYNTAX score was retrospectively calculated and the ClinSS was calculated using age, ejection fraction and creatinine clearance. A stratified comparison was then performed for all-cause mortality, cardiac death, and major adverse cardiac and cerebrovascular events (MACCE). Tertiles for SS and ClinSS were defined as SSlow (0-22), SSmid (23-32), SShigh (>32) and ClinSSlow (0-42), ClinSSmid (43-89) and ClinSShigh (>89), respectively. Completeness of revascularization rate was 94%, with no significant difference among tertiles. At 1 year, MACCE rates were 11%, 14%, 18% (p=0.01) and at 5 years 21%, 26%, 38%, for low, mid and high SS, respectively (p<0.0001). All-cause mortality at 5 years was 19%, 24%, 28%, respectively (p=0.003). Stratifying outcomes across ClinSS tertiles led to similar results. Five-year MACCE rates were 20%, 24%, 41% for low, mid and high ClinSS, respectively (p<0.0001). SYNTAX score and ClinSS were indipendent predictors of 5-year MACCE; ClinSS was an indipendent predictor for 5-year mortality. The ROC curve analysis showed a good predictive power of SS and ClinSS for 5-year MACCE (AUC 0.64, 95%CI 0.58-0.67; and AUC 0.67; 95%CI 0.60-0.72; respectively), 5-year all-cause mortality (AUC 0.61; 95%CI 0.52-0.68; and AUC 0.70; 95%CI 0.59-0.77; respectively), and 5-year cardiac-related mortality (AUC 0.62; 95%CI 0.58-0.71; and AUC 0.68; 95%CI 0.58-0.75; respectively).
In conclusion, SYNTAX score and Clinical SYNTAX score predicted outcomes of patients undergoing surgical myocardial revascularization and they have an important role to play in the risk stratification of this population.
- © 2012 by American Heart Association, Inc.