Redevelopment And Validation Of The SYNTAX Score II To Individualise Decision Making Between Percuta

Researchers sought to develop an individualized decision making tool that may aid in selecting an optimal revascularization strategy in patients with complex coronary artery disease. In the SYNTAX Extended Survival (SYNTAXES) study, which is an investigator-driven extension follow-up of a multicentre, randomised controlled trial conducted in 85 hospitals across 18 North American and European countries between March, 2005, and April, 2007, random assignment (1:1) of patients with de-novo three-vessel and left main coronary artery disease was done to either the percutaneous coronary intervention (PCI) group or coronary artery bypass grafting (CABG) group. Using Cox regression, a clinical prognostic index for prediction of death over a 10-year period was developed; in a second stage, this was combined with assigned treatment (PCI or CABG) and two prespecified effect-modifiers, which were chosen on the basis of previous evidence: disease type (three-vessel disease or left main coronary artery disease) and anatomical SYNTAX score. Similar techniques were used to create a model to prognosticate the 5-year risk of major adverse cardiovascular events (defined as a composite of all-cause death, non-fatal stroke, or non-fatal myocardial infarction) in cases undergoing PCI or CABG. These models were assessed for their utility in predicting the risk of death or a major adverse cardiovascular event, and their differences (ie, the estimated benefit of CABG versus PCI by calculating the absolute risk difference between the two strategies) by cross-validation with the SYNTAX trial (n = 1,800 participants) and external validation in the pooled population (n = 3,380 participants) of the FREEDOM, BEST, and PRECOMBAT trials. Per findings, the newly developed SYNTAX score II, termed SYNTAX score II 2020, for predicting 10-year deaths and 5-year major adverse cardiovascular events seems to be valuable for identification of individuals who will benefit from either CABG or PCI, hence supporting heart teams, patients, and their families to choose optimal revascularization strategies.

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