Potential Utility of the SYNTAX Score 2 in Patients Undergoing Left Main Angioplasty

Use of the SYNTAX Score II to predict mortality in interventional cardiology: A systematic review and meta-analysis

BACKGROUND

As the SYNTAX Score has limitations, it should be replaced by another better angiographic tool. By comparing mortality that was observed following percutaneous coronary intervention (PCI) in patients who were allotted a low versus a high score, we aimed to systematically investigate mortality prediction using the SYNTAX Score II in Interventional Cardiology.

METHODS

Electronic databases were searched for relevant publications using the terms "SYNTAX Score II and percutaneous coronary intervention." The main outcome was all-cause mortality. This analysis was carried out by the RevMan 5.3 software [risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated].

RESULTS

A total number of 9443 participants were enrolled for this analysis. As different studies reported different range of SYNTAX Score II, we further classified these scores range into 4 different groups: 17 < SS > 17, 20 < SS > 20, 22 < SS > 22, and 26 < SS > 26 appropriately. Results of this analysis showed that the risk of mortality in patients with a high SYNTAX Score II (SS > 17) was significantly higher (RR: 2.65, 95% CI: 1.05-6.73; P = .04) than patients with a low SYNTAX Score II (SS < 17). Even when participants with a low SYNTAX Score II (SS < 20) were compared with patients who were assigned to a higher SYNTAX Score II (SS > 20), a significantly higher risk of mortality was associated with a high SYNTAX Score II (RR: 3.73, 95% CI: 1.99 - 6.96; P = .0001).

CONCLUSION

Following PCI, the risk of mortality was higher in those patients with a high SYNTAX Score II. The SYNTAX Score II might be considered as an important tool to predict mortality in Interventional Cardiology. Future research should further explore the benefits of this tool.

Application of the SYNTAX score in interventional cardiology: A systematic review and meta-analysis

BACKGROUND

Should the SYNTAX score be integrated in Interventional Cardiology? Should it really be considered as a vital decision-making tool in percutaneous coronary intervention (PCI)? To confirm the importance of this score, we aimed to systematically compare the postinterventional adverse cardiovascular outcomes which were observed in patients who were allotted a low versus a high SYNTAX score.

METHODS

Randomized controlled trials and observational studies which were published from January 2007 to January 2017 were identified from MEDLINE, EMBASE, and the Cochrane databases using the searched terms 'SYNTAX score and percutaneous coronary intervention.' Adverse cardiovascular outcomes were considered as the major endpoints. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the statistical parameters, and the main analysis was carried out by the RevMan 5.3 software.

RESULTS

Sixteen studies with a total number of 19,751 participants (8589 participants with a low versus 11,162 participants with a high SYNTAX score) were included. Current results showed mortality to be significantly higher with a higher SYNTAX score (RR 2.09, 95% CI 1.78-2.46, P = .00001). Cardiac death also significantly favored a low SYNTAX score (RR 2.08, 95% CI 1.66-2.61, P = .00001. Similarly, myocardial infarction, major adverse cardiac events, repeated revascularization, and stent thrombosis were significantly higher following a high SYNTAX score (RR 1.71, 95% CI 1.45-2.03, P = .00001; RR 2.03, 95% CI 1.81-2.26, P = .00001; RR 1.96, 95% CI 1.69-2.28, P = .00001; and RR 3.16, 95% CI 2.17-4.59, P = .00001, respectively). Even when patients with ST-segment elevation myocardial infarction were separately analyzed, a low SYNTAX score was still significantly associated with lower adverse outcomes.

CONCLUSIONS

This analysis is a confirmatory piece of evidence to show that the application of the SYNTAX score in Interventional Cardiology is apparently relevant. The use of this scoring system to grade patients with coronary artery disease and to further guide for revascularization should be encouraged.

Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery and the SYNTAX score: A systematic review and meta-analysis

The SYNTAX [Synergy Between percutaneous coronary intervention (PCI) With Taxus and coronary artery bypass surgery (CABG)] score is a decision-making tool in interventional cardiology. However, several facts still remain to be addressed: What about PCI or CABG with a low versus a high score respectively? And what about PCI with a low score versus CABG with a high score? Electronic databases were carefully searched for relevant publications. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated and the analysis was carried out by RevMan 5.3. Eleven studies with a total number of 11,037 patients were included. In terms of clinical outcomes, this analysis showed PCI to have significantly favored patients with a low versus a high SYNTAX score. In patients who were re-vascularized by CABG, mortality and major adverse cardiac events were significantly lower with a low SYNTAX score. However, when PCI with a low SYNTAX score was compared with CABG with a high SYNTAX score, no significant difference in mortality and combined death/stroke/myocardial infarction were observed. In conclusion, the SYNTAX score might be considered useful in interventional cardiology. Nevertheless, the fact that it has limitations when compared to newer tools should also not be ignored.