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VA SYNTAX Score and Clinical Outcomes After Revascularization
Study Questions:
Can an automated, simplified anatomical scoring system from the Veteran Affairs (VA) Clinical Assessment, Reporting, and Tracking Program predict clinical outcomes among patients undergoing coronary revascularization?
Methods:
A simplified anatomical scoring system for coronary artery disease complexity before revascularization was adapted to data from the VA Clinical Assessment, Reporting, and Tracking Program. The adjusted association between quantified anatomical complexity and major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, stroke, and repeat revascularization, was assessed for patients undergoing percutaneous or surgical revascularization.
Results:
Over 50,000 patients (98% men) who underwent revascularization (34,322 percutaneous coronary intervention [PCI] and 15,904 coronary artery bypass grafting [CABG]) were included. After adjustment for confounders, the highest tertile of anatomical complexity was associated with increased hazard of MACCE (adjusted hazard ratio [HR], 2.12; 95% confidence interval [CI], 2.01-2.23). In contrast, the highest tertile of anatomical complexity among patients undergoing CABG was not independently associated with overall MACCE (adjusted HR, 1.04; 95% CI, 0.92-1.17), and only repeat revascularization was associated with increasing complexity (adjusted HR, 1.34; 95% CI, 1.06-1.70) in this subgroup.
Conclusions:
The VA SYNTAX score is a simple, automated score to assess anatomic complexity and can be used to assess longitudinal risk in patients undergoing coronary revascularization.
Perspective:
The SYNTAX score is a validated anatomical scoring system used to predict outcomes among patients with coronary artery disease and undergoing revascularization. It requires entering findings for each specific patient to calculate a score. Although it is straightforward, it does require time. The VA SYNTAX score uses registry data to automatically calculate a score, which appears to be associated with predicting adverse outcomes in patients undergoing PCI. Interestingly, the only association between the VA SYNTAX and surgical revascularization was for the endpoint of revascularization. Although a simplified version of the SYNTAX score would be helpful, the applicability of the VA SYNTAX score would have to be confirmed in non-VA populations and in women (98% male cohort) prior to widespread use.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease
Keywords: Cardiac Surgical Procedures, Coronary Artery Bypass, Coronary Artery Disease, Myocardial Infarction, Myocardial Revascularization, Patient Outcome Assessment, Percutaneous Coronary Intervention, Risk Assessment, Stroke, Vascular Diseases, Veterans
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