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Review
. 2020 Dec 15:2020:8822308.
doi: 10.1155/2020/8822308. eCollection 2020.

Fallacies and Possible Remedies of the SYNTAX Score

Yong-Ming He  1 , Li Shen  2 , Jun-Bo Ge  2
Affiliations
Review

Fallacies and Possible Remedies of the SYNTAX Score

Yong-Ming He et al. J Interv Cardiol. .

Abstract

Quite a few studies have revealed the clinical values regarding the outcome predictions in the cohort of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial and decision-making with the SYNTAX score. The Evaluation of Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left-Main Revascularization (EXCEL) and Nordic-Baltic-British left main revascularization (NOBLE) studies are the largest international randomized studies so far, comparing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) in the treatment of left main coronary artery disease. Unfortunately, both studies failed to validate the value of the SYNTAX score in the selection of revascularization strategies for patients with coronary artery diseases (CAD).. This scenario prompted us to reconsider the inherent fallacies of the SYNTAX score in its derivation. We pointed out eight fallacies for the SYNTAX score in this paper. A recently developed Coronary Artery Tree description and Lesion EvaluaTion (CatLet) score, available at http://www.catletscore.com, a novel angiographic scoring system, could be the remedies for the SYNTAX score.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Failures in reflection of the variability in RCA blood supply to the LV in the SYNTAX score. (a) The RCA did not supply blood to the LV, which was defined as left dominant in the SYNTAX score. (b)–(f) The RCA, varying greatly in size, supplied blood to the LV, which was defined as right dominant and was assigned the same weighting in the SYNTAX score. LV = left ventricle; RCA = right coronary artery.
Figure 2
Figure 2
The need for adapting modification in the scoring of the LAD in the presence of a significant diagonal preceding the lesion. In the right anterior oblique 30°/caudal 20° view, the proximal LAD was totally occluded. A significant diagonal without a significant stenosis preceded the occlusive lesion. LAD = left anterior descending artery.
See this image and copyright information in PMC

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References

    1. Sianos G., Morel M. A., Kappetein A. P., et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention :Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2005;1:219–227. - PubMed
    1. Wykrzykowska J. J., Garg S., Girasis C., et al. Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus eluted from a durable versus ERodable stent coating) trial. Journal of the American College of Cardiology. 2010;56(4):272–277. doi: 10.1016/j.jacc.2010.03.044. - DOI - PubMed
    1. Garg S., Serruys P. W., Silber S., et al. The prognostic utility of the SYNTAX score on 1-year outcomes after revascularization with zotarolimus- and everolimus-eluting stents. JACC: Cardiovascular Interventions. 2011;4(4):432–441. doi: 10.1016/j.jcin.2011.01.008. - DOI - PubMed
    1. Cavalcante R., Sotomi Y., Mancone M., et al. Impact of the SYNTAX scores I and II in patients with diabetes and multivessel coronary disease: a pooled analysis of patient level data from the SYNTAX, PRECOMBAT, and BEST trials. European Heart Journal. 2017;38(25):1969–1977. doi: 10.1093/eurheartj/ehx138. - DOI - PubMed
    1. Neumann F. J., Sousa-Uva M., Ahlsson A., et al. ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. 2018;40:87–165. - PubMed

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