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Comparative Study
. 2020 Jan-Dec:14:1753944720924254.
doi: 10.1177/1753944720924254.

Inter-observer variation of Syntax score among cardiac surgeons, clinical and interventional cardiologists

Gustavo Neves de Araujo  1   2 , Tiago Luiz Luz Leiria  3 , Mariana Vargas Furtado  3 , Bruno da Silva Matte  3 , Guilherme Pinheiro Machado  2   3 , Ana Maria Krepsky  3 , Luiz Carlos Corsetti Bergoli  2   3 , Sandro Cadaval Goncalves  2   3 , Marco Vugman Wainstein  2   3 , Carisi Anne Polanczyk  2   3
Affiliations
Comparative Study

Inter-observer variation of Syntax score among cardiac surgeons, clinical and interventional cardiologists

Gustavo Neves de Araujo et al. Ther Adv Cardiovasc Dis. 2020 Jan-Dec.

Abstract

Background: Despite the complexity of SYNTAX score (SS), guidelines recommend this tool to help choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with left main of three-vessel coronary artery disease. The aim of this study was to compare the inter-observer variation in SS performed by clinical cardiologists (CC), interventional cardiologists (IC), and cardiac surgeons (CS).

Methods: Seven coronary angiographies from patients with left main and/or three-vessel disease chosen by a heart team were analyzed by 10 CC, 10 IC and 10 CS. SS was calculated via SYNTAX website.

Results: Kappa concordance was very low between CC and CS (k = 0.176), moderate between CS and IC (k = 0.563), and moderate between CC and IC (0.553). There was a statistically significant difference between CC, who classified more cases as low complexity (70%), and CS, who classified more cases as moderate complexity (80%) (p = 0.041).

Conclusion: Concordance between SS analyzed by CC, CS and IC is low. The usefulness of SS in decision-making of revascularization strategy is undeniable and evidence supports its use. However, this study highlights the importance of well-trained professionals on calculating the SS. It could avoid misclassification of borderline cases.

Keywords: SYNTAX score; coronary artery bypass graft; left main; multivessel disease; percutaneous coronary intervention.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Mean/Median* SYNTAX score among different cardiology professionals.
Figure 2.
Figure 2.
Case 5 coronary angiography images. (a) Right anterior oblique caudal projection of left coronary artery. (b) Posteroanterior cranial projection of left coronary artery. (c) Left anterior oblique cranial projection of left coronary artery. (d) Left anterior oblique projection of right coronary artery.
See this image and copyright information in PMC

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