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. 2021 Sep 3;16(1):248.
doi: 10.1186/s13019-021-01616-6.

Surgical and percutaneous revascularization outcomes based on SYNTAX I, II, and residual scores: a long-term follow-up study

Eduardo Bello Martins  1 , Whady Hueb  2 , David L Brown  3 , Thiago Luis Scudeler  1 , Eduardo Gomes Lima  1 , Paulo Cury Rezende  1 , Paulo Rogério Soares  1 , Cibele Larrosa Garzillo  1 , Jaime Paula Pessoa Linhares Filho  1 , Daniel Valente Batista  1 , Jose Antonio Franchini Ramires  1 , Roberto Kalil Filho  1
Affiliations

Surgical and percutaneous revascularization outcomes based on SYNTAX I, II, and residual scores: a long-term follow-up study

Eduardo Bello Martins et al. J Cardiothorac Surg. .

Abstract

Background: The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up.

Methods: This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE.

Results: In the CABG sample, SSI had a median of 23 (IQR 17-29.5), median SSII of 25.4 (IQR 19.2-32.8), and median rSS of 2 (IQR 0-6.5); in PCI SSI had a median of 14 (IQR 10-19.1), median SSII of 28.7 (IQR 23-34.2), and median rSS of 4.7 (IQR 0-9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13-3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74-10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01-1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function.

Conclusion: Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis.

Keywords: Coronary angiography; Coronary artery bypass grafting; Coronary artery disease; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves showing combined events (MACCE) and death. CABG coronary artery bypass grafting, MACCE major adverse cardiovascular and cerebrovascular events, PCI ercutaneous coronary intervention
Fig. 2
Fig. 2
Subgroup analysis for MACCE. CABG coronary artery bypass grafting, CrCl creatine clearance, EF ejection fraction, MACCE major adverse cardiovascular and cerebrovascular events, PCI percutaneous coronary intervention, SSI SYNTAX score I, SSII SYNTAX score II, rSS residual SYNTAX score
See this image and copyright information in PMC

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