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Coronary atherosclerotic burden assessed by SYNTAX scores and outcomes in surgical, percutaneous, or medical strategies: A retrospective cohort study

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Aug 23, 2022 version files 276.29 KB

Abstract

Introduction
 
Coronary atherosclerotic burden and SYNTAX score (SS) are predictors of cardiovascular events. 
 
Objectives
 
To investigate the value of SYNTAX scores (SS, SSII and residual SS [rSS]) for predicting cardiovascular events in patients with coronary artery disease (CAD). 
 
Design
 
Retrospective cohort study. 
 
Setting
 
Single tertiary centre. 
 
Participants
 
Medicine, Angioplasty or Surgery Study (MASS) database patients with stable multivessel CAD and preserved ejection fraction. 
 
Interventions CAD patients undergoing coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), or medical treatment (MT) alone from January 2002 to December 2015. 
 
Primary and secondary outcomes Primary: 5-year all-cause mortality. Secondary: composite of all-cause death, myocardial infarction, stroke, and subsequent coronary revascularization at 5 years. 
 
Results
 
A total of 1,719 patients underwent PCI (n = 573), CABG (n = 572), or MT (n = 574) alone. The SS was not considered an independent predictor of 5-year mortality in the PCI (low, intermediate and high SS 6.5%, 6.8% and 4.3%, respectively, p=0.745), CABG (low, intermediate and high SS 5.7%, 8.0% and 12.1%, respectively, p=0.194) and MT (low, intermediate and high SS 6.8%, 6.9% and 6.5%, respectively, p=0.993) cohorts. The SSII (low, intermediate and high SSII, 3.6% vs. 7.9% vs. 10.5%, respectively, p <0.001) was associated with a higher mortality risk in the overall population. Within each treatment strategy, SSII was associated with a significant 5-year mortality rate, especially in CABG patients with higher SSII (low, intermediate and high SSII, 1.8%, 9.7% and 10.0%, respectively, p = 0.004) and in MT patients with high SSII (low, intermediate and high SSII, 5.0%, 4.7% and 10.8%, respectively, p = 0.031). SSII demonstrated a better predictive accuracy for mortality compared with SS and rSS (c-index = 0.62) 
 
Conclusions
 
Coronary atherosclerotic burden alone was not associated with significantly increased risk of all-cause mortality. The SSII better discriminates the risk of death.