Original title: Validation and Comparison of the Long-Term Prognostic Capability of SYNTAX Store-II Among 1528 Consecutive Patients Who Underwent Left Main Percutaneous Coronary Intervention. Reference: Bo Xu, et al. JACC Cardiovascular Intervention 2014;7:1128-37.

The SYNTAX angiography score is useful when deciding revascularization in multivessel, but with the addition of clinical variables in the second version, SYNTAX score has improved its performance in predicting mortality. 1528 consecutive patients who underwent angioplasty to left main coronary artery unprotected were analyzed. The primary endpoint was the ability of the SYNTAX score II to predict mortality. Patients were divided into 3 tertiles: ≤21 points with 508 patients, >21 and ≤28 points with 480 patients and >28 points with 540 patients. Those in the highest tertile had higher age, more women, more history of heart attack and stroke, lower ejection fraction, creatinine clearance, and greater coronary disease with more complex lesions and presence of 2 or 3 vessels. At follow-up to four years, the rate of death, cardiac death, myocardial infarction and target vessel revascularization was respectively 4.4%, 5%, 7.5% and 9.5%, being significantly higher in the highest and intermediate tertile. In the multivariate, the SYNTAX Score II was predictor of mortality (HR: 1.76, 95% IC: 1.1 to 2.82 p = 0.02) in patients receiving angioplasty in the unprotected left main coronary artery (ULMCA). Besides the classic SYNTAX angiographic score and SYNTAX score II were compared giving the latter a better prediction of long-term mortality and a 25% index of reclassifying patients.

Conclusion

The results of this important series of consecutive patients who underwent angioplasty to unprotected left main coronary artery suggests that the SYNTAX score II has greater power to predict mortality compared with classic SYNTAX angiographic score.

Comment

The SYNTAX score II is helpful because it combines clinical with anatomy predicting late mortality. This tool should be used in all patients when deciding revascularization strategy. It will be necessary to set randomized studies comparing surgery with angioplasty combining the different SYNTAX Scores (SS residual, Syntax revascularization index, Syntax Delta Score) along with second-generation DES plus FFR and endovascular diagnostic imaging methods (IVUS or OCT) to evaluate these strategies in the current era. 

Courtesy Dr. Carlos Fava
Interventional cardiologist
Favaloro Foundation
Buenos Aires – Argentina

Carlos Fava