Abstract 16316: Impact of SYNTAX Score on the Late Outcomes after Off-Pump Coronary Artery Bypass Grafting
Background: In the SYNTAX trial major adverse cardiac or cerebrovascular events (MACCE) were significantly higher for percutaneous coronary intervention (PCI) than coronary artery bypass grafting (CABG), especially in high SYNTAX score subgroup. Although the prognostic value of the SYNTAX score has been highlighted in patients undergoing PCI for ischemic heart disease, its prognostic value in patients undergoing CABG is still unknown. The aim of this study was to evaluate the impact of SYNTAX score on the late outcomes after off-pump CABG.
Methods: We reviewed the records of 496 consecutive patients undergoing isolated off-pump CABG between 2001 and 2008. From the review of preoperative coronary angiography, patients were divided into three groups (low: 0-22; n=241, intermediate: 23-32; n=184, high: ≥33; n=71) according to SYNTAX score. Primary endpoint was MACCE, including all-cause death, myocardial infarction, stroke, and repeat revascularization. Kaplan-Meier method was used for time-related events. Mean follow-up period was 4.7±1.3 years.
Results: Preoperative clinical characteristics and risk factors were almost compatible between the groups, except for increasing rates of hyperlipidemia in patients with higher SYNTAX score. Cumulative MACCE rates at 2 years were 9.6±2.0% in low group, 11.2±2.4% in intermediate group and 3.6±2.5% in high group, but it increased 23.7±3.1% in low group, 23.1±3.8% in intermediate group and 26.6±7.3% in high group at 5 years (figure).
Conclusions: MACCE rate after off-pump CABG was rather lower in high SYNTAX score group until three years. However it increased sharply after three years, mainly driven by higher all-cause death. Careful follow-up is required after off-pump CABG in patients with high SYNTAX score.
- © 2012 by American Heart Association, Inc.