Log in to MyACC
SYNTAX Score in Patients With Diabetes Undergoing Revascularization
Study Questions:
What is the utility of the SYNTAX score (SS) in predicting future cardiovascular events in patients with diabetes mellitus (DM) and multivessel disease (MVD) undergoing revascularization?
Methods:
The FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial randomized 1,900 patients with DM and MVD to coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) with drug-eluting stents. In this study, SS were retrospectively adjudicated in FREEDOM trial patients and stratified by previously validated SS thresholds in a core lab; low (<23), intermediate (23-32), and high (>32). Multivariate prediction modeling and receiver-operating characteristic (ROC) curves were used to evaluate the utility of SS to predict hard cardiovascular events (HCE) and major adverse cardiovascular and cerebrovascular events (MACCE) over a median follow-up of 3.8 years.
Results:
Of the 1,900 patients included in this study, 947 were in the CABG arm and 953 were in the PCI arm. Mean SS was 26.1 ± 8.8 in the CABG group and 26.2 ± 8.4 in the PCI group (p = 0.67). In the CABG group, no difference in MACCE and HCE rates was noted by SS thresholds. In the PCI group, there was a significant difference in MACCE rates and a nonsignificant difference in HCE rates by SS thresholds. In the PCI cohort, left ventricular ejection fraction <40%, insulin use, creatinine clearance <60 ml/min, SS (hazard ratio per unit of SS, 1.02; 95% confidence interval, 1.00-1.03; p = 0.014) independently predicted MACCE and HCE at 5 years. Although SS was an independent risk factor for MACCE, ROC curves showed a poor discrimination capability of SS for MACCE and HCE. In the CABG group, SS did not independently predict MACCE or HCE. Additionally, higher MACCE and repeat revascularization was noted with PCI when compared to CABG regardless of SS threshold in this cohort.
Conclusions:
In patients with DM and MVD, the complexity of CAD evaluated by the SS is an independent risk factor for MACCE only in patients undergoing PCI. The SS should not be utilized to guide the choice of coronary revascularization in patients with DM and multivessel CAD.
Perspective:
This study reports utility of the SS in DM patients undergoing revascularization for MVD. Findings confirm our existing suspicion that CABG is a superior revascularization strategy in patients with DM and MVD regardless of SS. A high SS only predicted worse outcomes with PCI but not CABG in these patients with DM and MVD. SS as a method of assessing anatomic CAD severity and a guide to revascularization strategy should only be used in nondiabetics with MVD in the current era.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and SIHD, Chronic Angina
Keywords: Angina Pectoris, Variant, Cardiac Surgical Procedures, Coronary Artery Bypass, Creatinine, Diabetes Mellitus, Drug-Eluting Stents, Insulin, Myocardial Revascularization, Percutaneous Coronary Intervention, Risk Factors, ROC Curve, Secondary Prevention, Stroke Volume
< Back to Listings
