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Meta-Analysis
. 2017 Jul;96(28):e7410.
doi: 10.1097/MD.0000000000007410.

Application of the SYNTAX score in interventional cardiology: A systematic review and meta-analysis

Pravesh Kumar Bundhun  1 , Yashna Sookharee, Anita Bholee, Feng Huang
Affiliations
Meta-Analysis

Application of the SYNTAX score in interventional cardiology: A systematic review and meta-analysis

Pravesh Kumar Bundhun et al. Medicine (Baltimore). 2017 Jul.

Abstract

Background: Should the SYNTAX score be integrated in Interventional Cardiology? Should it really be considered as a vital decision-making tool in percutaneous coronary intervention (PCI)? To confirm the importance of this score, we aimed to systematically compare the postinterventional adverse cardiovascular outcomes which were observed in patients who were allotted a low versus a high SYNTAX score.

Methods: Randomized controlled trials and observational studies which were published from January 2007 to January 2017 were identified from MEDLINE, EMBASE, and the Cochrane databases using the searched terms 'SYNTAX score and percutaneous coronary intervention.' Adverse cardiovascular outcomes were considered as the major endpoints. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the statistical parameters, and the main analysis was carried out by the RevMan 5.3 software.

Results: Sixteen studies with a total number of 19,751 participants (8589 participants with a low versus 11,162 participants with a high SYNTAX score) were included. Current results showed mortality to be significantly higher with a higher SYNTAX score (RR 2.09, 95% CI 1.78-2.46, P = .00001). Cardiac death also significantly favored a low SYNTAX score (RR 2.08, 95% CI 1.66-2.61, P = .00001. Similarly, myocardial infarction, major adverse cardiac events, repeated revascularization, and stent thrombosis were significantly higher following a high SYNTAX score (RR 1.71, 95% CI 1.45-2.03, P = .00001; RR 2.03, 95% CI 1.81-2.26, P = .00001; RR 1.96, 95% CI 1.69-2.28, P = .00001; and RR 3.16, 95% CI 2.17-4.59, P = .00001, respectively). Even when patients with ST-segment elevation myocardial infarction were separately analyzed, a low SYNTAX score was still significantly associated with lower adverse outcomes.

Conclusions: This analysis is a confirmatory piece of evidence to show that the application of the SYNTAX score in Interventional Cardiology is apparently relevant. The use of this scoring system to grade patients with coronary artery disease and to further guide for revascularization should be encouraged.

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Figures

Figure 1
Figure 1
Flow diagram which represents the study selection.
Figure 2
Figure 2
Postinterventional adverse cardiovascular outcomes which were observed between a low versus a higher (tertiles II and III) SYNTAX score.
Figure 3
Figure 3
Postinterventional adverse cardiovascular outcomes which were observed between a low versus a higher (tertiles II and III) SYNTAX score using data which were obtained only from randomized controlled trials.
Figure 4
Figure 4
Postinterventional adverse cardiovascular outcomes which were observed between a low (SS ≤ 10) versus a higher (tertiles II and III) SYNTAX score. SS = SYNTAX score.
Figure 5
Figure 5
Postinterventional adverse cardiovascular outcomes which were observed between a low (10 > SS ≤ 20) versus a higher (tertiles II and III) SYNTAX score. SS = SYNTAX score.
Figure 6
Figure 6
Postinterventional adverse cardiovascular outcomes which were observed between a low (10 > SS ≤ 20) versus a higher (tertiles II and III) SYNTAX score. SS = SYNTAX score.
Figure 7
Figure 7
Postinterventional adverse cardiovascular outcomes which were observed between a low (20 > SS < 30) versus a higher (tertiles II and III) SYNTAX score. SS = SYNTAX score.
Figure 8
Figure 8
Postinterventional adverse cardiovascular outcomes which were observed between a low (30 > SS < 40) versus a higher (tertiles II and III) SYNTAX score. SS = SYNTAX score.
Figure 9
Figure 9
Postinterventional adverse cardiovascular outcomes which were observed between a low (30 > SS < 40) versus a higher (tertiles II and III) SYNTAX score. SS = SYNTAX score.
Figure 10
Figure 10
Postinterventional adverse cardiovascular outcomes which were observed between a low versus an intermediate (tertile II) SYNTAX score.
Figure 11
Figure 11
Postinterventional adverse cardiovascular outcomes which were observed between a low versus a high (tertile III) SYNTAX score.
Figure 12
Figure 12
Postinterventional adverse cardiovascular outcomes which were observed between a low versus a higher (tertile II + III) SYNTAX score in patients with STEMI. STEMI = ST-segment elevation myocardial infarction.
Figure 13
Figure 13
Postinterventional major adverse cardiac events which were observed between a low versus a higher (tertile II + III) SYNTAX score in patients with STEMI. STEMI = ST-segment elevation myocardial infarction.
Figure 14
Figure 14
Funnel plot (A) representing publication bias.
Figure 15
Figure 15
Funnel plot (B) representing publication bias.
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