The rate of discordance between syntax score ii and cardiologist decision as a guide for mode of revascularization in patients with complex coronary artery disease

Abstract EN

Background: The SYNTAX score (SS) II is an objective tool for predicting 4-year mortality and guiding treatment decisions for percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG) in patients with complex coronary artery disease (CAD) and/or unprotected left main stem disease (ULMSD).

Objectives: To assess the agreement between the clinical decisions of the cardiologist and the SS II recommendation regarding the revascularization strategies in patients with complex CAD and/or ULMSD.

Patients and Methods: Prospective data from patients who presented to Baghdad Medical City Catheterization Labs for coronary angiography and were followed up between January 2014 and November 2015 were analyzed.

For these patients, SS II was assessed by the two anatomical variables (SS and presence of ULMSD) and six clinical variables (age, creatinine clearance, left ventricular ejection fraction, sex, chronic obstructive pulmonary disease, and peripheral vascular disease) to predict 4-year mortality after revascularization with PCI and/or CABG.

These scores were then compared with the clinical decisions of cardiologists.

After 1 year of data collection, we followed up the patients by phone to assess their mortality status.

Patients were categorized into three groups according the interventional procedures: Group 1 (for PCI), Group 2 (for CABG), and Group 3 (for PCI vs.

CABG).

Results: Two hundred patients were enrolled.

Their mean age was 60.23 ± 9.836 years, and 157 (78.5%) were men.

Depending on the clinical judgment of the cardiologist, 71 (35.5%) patients were referred for PCI (Group 1), 119 (59.5%) patients for CABG (Group 2), and the remaining 10 (5%) patients for PCI vs.

CABG (Group 3).

Based on an assessment of 4-year mortality by the SS II, CABG would have been the treatment of choice in 67 (33.5%) patients, PCI in 30 (15%) patients, and both the treatments in 103 (51.5%) patients.

There was a concordance between the clinical decision of the cardiologist and SS II in 67 (33.5%) patients and discordance in 133 (66.5%) patients.

Six patients died within 1 year, most of whom were from the discordant group.

Conclusion: There was a statistically significant discordance between the SS II recommendation and clinical judgment of the interventional cardiologist.

SS II proved to be a useful objective tool to assist experienced clinical judgment in determining appropriate revascularization strategy for CAD patients.

Keywords: SYNTAX score, complex coronary artery disease, coronary revascularization