Long-term outcomes of patients with complex coronary artery disease according to agreement between the SYNTAX score and revascularization procedure in contemporary practice

AIMS: The SYNTAX score (SS) has been shown to identify subgroups of patients with left main or triple-vessel coronary artery disease (LM/3VCAD) that can be treated with a percutaneous coronary intervention (PCI) with equal clinical outcomes as coronary artery bypass surgery (CABG).We sought to assess the adequacy of referral to PCI/CABG of patients with LM/3VCAD at our institution. PATIENTS AND METHODS: We retrospectively matched all patients with LM/3VCAD referred to CABG (n=145) to patients referred to PCI in our institution during 2009-2010. We calculated the SS and clinical SS (cSS) according to the European Society of Cardiology guidelines and compared the agreement rates between the revascularization modality and the SS as well as clinical outcomes at the 3-year follow-up. RESULTS: The overall agreement rates between the revascularization procedure and the SS was 67%, for example the rate was higher in patients referred to PCI compared with CABG (78 vs. 49%) and patients with 3VCAD compared with patients with LMCAD (68 vs. 51%). Patients without agreement between the revascularization modality and the SS had higher rates of combined adverse cardiac events (42.6 vs. 27% P=0.008). Similar results were observed when using the cSS at different cutoff levels. CONCLUSION: At our institution, there was considerable disagreement between a clinical judgment-based coronary revascularization and the SS/cSS-based allocation process as to the preferred revascularization modality for patients with complex CAD. Our results suggest that integrating the SS/cSS into the decision-making process for assigning patients to revascularization would yield better clinical outcomes.