Cardiology Medical News about left main coronary artery disease;predicting clinical outcome after percutaneous coronary intervention

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Usefulness of the SYNTAX score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease
Circulation: Cardiovascular Interventions, 07/02/09

Capodanno D et al. – The SYNTAX score (SXscore) is a useful tool to predict cardiac mortality and major adverse cardiac events (MACE) in pts undergoing percutaneous revascularization of the left main coronary artery.

Methods

Application of SXscore in 255 consecutive pts who had percutaneous coronary intervention for left main disease
Assessment of SXscore performance related to clinical outcome
Univariate and multivariate Cox proportional hazard regression analyses to evaluate relation between SXscore and incidence of cardiac mortality and MACE
Primary endpoint: relation between SXscore and incidence of cardiac mortality

Results

At 1 yr, SXscore significantly predicted risk of cardiac death and MACE
After adjustment for potential confounders, a higher SXscore remained significantly associated with cardiac mortality and MACE
C-indexes for SXscores for cardiac death and MACE: 0.83 and 0.64, respectively
Using classification tree analysis, discrimination levels of 34 and 37 identified as optimal cutoff to distinguish between pts at low and high risk of cardiac death and MACE, respectively

Exclusive Author Commentary
Davide Capodanno, 07/02/09

This study validates the efficacy of SYNTAX score in predicting one-year clinical outcomes of patients undergoing left main PCI. The next challenge, however, is to understand if SYNTAX score effectively does what it was originally developed for, namely to be an aid in patient’s selection for the optimal revascularization treatment. For this purpose, a cut off of 34 has the potential to usefully distinguish patients at higher risk of cardiac death following PCI who may benefit most from surgery. Importantly, a number of potential drawbacks of SYNTAX score application emerged from this study: variables such as previous stenting or bypass grafting are not considered in the score algorithm; SYNTAX score calculation is not user-friendly, although some online tools are now available; finally, the parallel role of co-morbidities and clinical risk factors in predicting clinical outcomes of PCI patients remains an issue.

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