SYNTAX score and left main stenting: Do we need clinical variables to predict outcomes?
Article Outline
We have read with interest the article written by Capodanno et al1 related with the improvement of the SYNTAX score2 with the parallel use of clinical variables in left main stenting, and we appreciate the investigation in this challenging field. Since its presentation, there has been a progressive interest in this score, especially in left main disease, and there is a debate about if it is time to indicate percutaneous intervention instead of surgical revascularization.3, 4 We would like to emphasize some aspects that might limit the usefulness of SYNTAX score as the unique tool to indicate stenting in left main disease. First, the conclusions related with left main interventions in SYNTAX trial are the results of post hoc analysis. Second, in SYNTAX initially as many as 4,337 were assessed for eligibility and only 1,800 (41.5 %) were randomized. Of the remaining 2,537 that were excluded from randomization, 1,275 were only eligible for 1 of the 2 modalities of revascularization, and 1,077 of them (84.5%) were managed surgically. Third, the primary end point of noninferiority of percutaneous intervention in comparison with surgical revascularization was not met. Fourth, the follow-up in SYNTAX was limited only to the first year, and lastly, it has been a constant in previous studies that clinical features play an essential role not only in procedural success but also in the long-term outcome. We strongly believe that variables such as age, ejection fraction, diabetes, or renal failure that have been determinant in outcomes in previous series should never been excluded of decision making. Although SYNTAX has been a revolutionary trial, we want to congratulate Capodanno et al because of their rationale contribution in the challenging field of left main disease.
References
- EuroSCORE refines the predictive ability of SYNTAX score in patients undergoing left main percutaneous coronary intervention. Am Heart J. 2009;159:103–109
- Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–972
- . Left main coronary artery stenting: crossing the Rubicon. J Am Coll Cardiol. 2009;53:1769–1772
- Revascularization for unprotected left main disease: evolution of the evidence basis to redefine treatment standards. J Am Coll Cardiol. 2009;54:1576–1588
PII: S0002-8703(10)00155-9
doi:10.1016/j.ahj.2010.02.013
© 2010 Mosby, Inc. All rights reserved.
Refers to article:
- EuroSCORE refines the predictive ability of SYNTAX score in patients undergoing left main percutaneous coronary intervention
