SYNTAX Score II 2020 in Real-World Data

Quick Takes

  • SYNTAX score II 2020 (SSII-2020) predicted well the 5-year mortality after PCI and CABG in a large observational study population, and has the potential to support decision making on revascularization in patients with 3VD and/or LMCAD.
  • However, SSII-2020 for predicting 5-year MACE could not recommend a specific treatment with sufficient accuracy.
  • Additional studies are indicated to enhance the predictive accuracy of the SSII-2020 score and derivatives for MACE and longer-term outcomes to support clinical decisions for the selection of revascularization modality in patients with 3VD and/or LMCAD.

Study Questions:

What is the value of SYNTAX score II 2020 (SSII-2020) in identifying the safest modality of revascularization in a nonrandomized setting?

Methods:

The investigators assessed 5-year mortality and major adverse cardiac events (MACE) in 7,362 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) enrolled in a Japanese percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) registry. The discriminative abilities of the SSII-2020 were assessed using Harrell’s C-statistic. Agreement between observed and predicted event rates following PCI or CABG and treatment benefit (absolute risk difference [ARD]) for these outcomes were assessed by calibration plots.

Results:

The SSII-2020 for 5-year mortality well predicted the prognosis after PCI and CABG (C-index = 0.72, intercept = -0.11, slope = 0.92). When patients were grouped according to the predicted 5-year mortality ARD, <4.5% (equipoise of PCI and CABG) and ≥4.5% (CABG better), the observed mortality rates after PCI and CABG were not significantly different in patients with lower predicted ARD (observed ARD, 2.1%; 95% confidence interval [CI], -0.4% to 4.4%), and the significant difference in survival in favor of CABG was observed in patients with higher predicted ARD (observed ARD, 9.7%; 95% CI, 6.1%-13.3%). For MACE, the SSII-2020 could not recommend a specific treatment with sufficient accuracy.

Conclusions:

The authors concluded that the SSII-2020 for predicting 5-year death has the potential to support decision making on revascularization in patients with 3VD and/or LMCAD.

Perspective:

This real-world registry study reports that SSII-2020 for 5-year mortality predicted well the prognosis after PCI and CABG in a large observational study population, and therefore has the potential to support decision making on revascularization in patients with 3VD and/or LMCAD. However, SSII-2020 for predicting 5-year MACE could not recommend a specific treatment with sufficient accuracy. Additional studies are indicated to enhance the predictive accuracy of the SSII-2020 score and derivatives for MACE and longer-term outcomes to support clinical decisions for the selection of revascularization modality in patients with 3VD and/or LMCAD.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and Coronary Artery Disease

Keywords: Cardiac Surgical Procedures, Coronary Artery Bypass, Coronary Artery Disease, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Secondary Prevention


< Back to Listings