External Validation of the SYNTAX Score II 2020

• Published in: Journal of the American College of Cardiology Vol. 78; no. 12; pp. 1227 - 1238
• Main Authors: Hara, Hironori, Shiomi, Hiroki, van Klaveren, David, Kent, David M., Steyerberg, Ewout W., Garg, Scot, Onuma, Yoshinobu, Kimura, Takeshi, Serruys, Patrick W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 21.09.2021
• Subjects: Aged; CABG; Cardiovascular; Clinical Decision-Making; Coronary Artery Bypass - mortality; Decision Support Techniques; Female; Humans; Japan - epidemiology; Male; Middle Aged; PCI; Percutaneous Coronary Intervention - mortality; predictive model; Japan; 3VD; SSII-2020; predictive model; ARD; DES; MACE; PCI; CAD; IPTW; CABG; MCAD; coronary artery bypass grafting surgery; coronary artery disease; left main coronary artery disease; drug-eluting stents; major adverse cardiac and cerebrovascular events; SYNTAX score II 2020; inverse probability of treatment weights; percutaneous coronary intervention; 3-vessel disease; absolute risk difference
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2021.07.027

The SYNTAX score II 2020 (SSII-2020) was derived from cross correlation and externally validated in randomized trials to predict death and major adverse cardiac and cerebrovascular events (MACE) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with 3-vessel disease (3VD) and/or left main coronary artery disease (LMCAD). The authors aimed to investigate the SSII-2020’s value in identifying the safest modality of revascularization in a non-randomized setting. Five-year mortality and MACE were assessed in 7,362 patients with 3VD and/or LMCAD enrolled in a Japanese PCI/CABG registry. The discriminative abilities of the SSII-2020 were assessed using Harrell’s C statistic. Agreement between observed and predicted event rates following PCI or CABG and treatment benefit (absolute risk difference [ARD]) for these outcomes were assessed by calibration plots. The SSII-2020 for 5-year mortality well predicted the prognosis after PCI and CABG (C-index = 0.72, intercept = −0.11, slope = 0.92). When patients were grouped according to the predicted 5-year mortality ARD, <4.5% (equipoise of PCI and CABG) and ≥4.5% (CABG better), the observed mortality rates after PCI and CABG were not significantly different in patients with lower predicted ARD (observed ARD: 2.1% [95% CI: −0.4% to 4.4%]), and the significant difference in survival in favor of CABG was observed in patients with higher predicted ARD (observed ARD: 9.7% [95% CI: 6.1%-13.3%]). For MACE, the SSII-2020 could not recommend a specific treatment with sufficient accuracy. The SSII-2020 for predicting 5-year death has the potential to support decision making on revascularization in patients with 3VD and/or LMCAD. [Display omitted]