Abstract
Introduction
The most significant disadvantage of the SYNTAX score is the lack of an individualized approach due to the absence of the clinical parameters. The Syntax Score II calculator which includes 6 clinical indicators is more accurate decision-making tool that should help the “heart team” to choose a strategy for myocardial revascularization.
The purpose of the study was to examine the effectiveness of using Syntax Score II for patients with multi-vessel coronary artery lesions who was dedicated to PCI.
Material and methods
From 01/2018 to 12/2018, 760 patients were included in the research, who was dedicated to PCI by the decision of the local “heart team”. In present analysis were included 116 (15%) of these patients with the multi-vessel coronary lesion and with a left main coronary artery lesion of different complexity. Patients who had previously undergone myocardial revascularization were excluded from analysis. The age of patients ranged from 41 to 86 years (mean age 67 + 9 years). There were males - 67.2%. Diabetes mellitus was present in 34.5% of the patients. 42.2% of the patients had angina pectoris (NYHA 3–4), and 60.3% had II class chronic heart failure.
Results
The average Syntax Score of the 116 patients was 23.1 + 7.8 (from 11 to 59). Syntax Score of the 52 (44.8%) patients was more than 23, and less than 23 in 64 (55.2%) of the cases.
The Syntax Score II for the same patients recommended only CABG in 13 (11.2%), only PCI - in 6 (5.2%) and equality between methods - in 97 (83.6%) cases. Only in 6 (5.2%) patients, there was complete agreement between the risk scales, and for 53 (45.7%) of them, the methods were equal. For 44 (37.9%) patients, the Syntax score recommended CABG (Syntax score more than 23), and Syntax Score II indicated equality of methods. In 2 (1.7%) patients with a SYNTAX score of more than 23 the Syntax Score II nevertheless recommended PCI. The “heart team” decision and the Syntax Score II recommendation were in agreement in 103 (88.8%) of the cases, while the “heart team” decision and the SYNTAX recommendation were in agreement only in 64 (55.2%) of the cases.
At the hospital stage, there were 2 (1.7%) cases of stent thrombosis with a fatal outcome, both in patients with SYNTAX score 42 and 28.
To determine the degree of consistency between the risk scales, the Kappa Cohen coefficient was calculated, which was 0.06 (p=0.93), which indicates lack of consistency between SYNTAX and Syntax Score II in recommendations.
Conclusion
The Syntax Score II risk scale is an effective tool for making “heart team” decisions about myocardial revascularization method and expands indications for performing PCI, and in 88.8% of cases with multi-vessel coronary arteries lesion, it is possible to get equal predictions between the methods of revascularization. In 40% of cases in patients with a SYNTAX of more than 23 Syntax Score II determines an equiprobable prognosis for performing PCI and CABG.
APPROPRIATENESS OF MYOCARDIAL REVASCULARIZATION ASSESSED BY SYNTAX SCORE II IN A CENTRE WITHOUT ON-SITE CARDIAC SURGERY