American Heart Journal
Volume 159, Issue 5 , Page e27, May 2010

Response to: SYNTAX score and left main stenting: Do we need clinical variables to predict outcomes?

Cardiology Department, Ferrarotto Hospital, University of Catania, Italy

ETNA Foundation, Catania, Italy

Article Outline

 

We thank Lozano and Avanzas1 for their interest in our study and their appreciative comments. The points raised on the SYNTAX study are well taken in the spirit of giving a thoughtful interpretation of the trial results. However, these issues should not affect the expectation on the SYNTAX score, a tool that has been prespecifically developed by expert consensus outside of the trial setting and externally validated in a variety of clinical scenarios.2, 3, 4, 5 Differently, we concur that using the SYNTAX score as a stand-alone tool for predicting clinical outcomes after percutaneous coronary intervention may be of limited value if well-established clinical predictors of adverse events are not taken into account. Among them, age, ejection fraction, and creatinine level have been recently combined in a bedside predictive model, namely ACEF score, and proposed as the strongest determinants of mortality in elective patients undergoing cardiac surgery, thus contributing to shift the paradigm that the more variables we include in risk models, the more accurate these models will be.6 Keeping in line with our demonstration that clinical variables improve the predictive and discriminatory ability of the SYNTAX score, a simple approach combining the SYNTAX and ACEF scores (Clinical SYNTAX score), is currently under testing. Whether the Clinical SYNTAX score or the Global Risk Classification7 may be conveniently implemented in clinical decision making warrants further investigations.

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References 

  1. Lozano I, Avanzas P. SYNTAX score and left main stenting: do we need clinical variables to predict outcomes?. Am Heart J. 2010;159:e25
  2. Valgimigli M, Serruys PW, Tsuchida K, et al. Cyphering the complexity of coronary artery disease using the Syntax score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention. Am J Cardiol. 2007;99:1072–1081
  3. Capodanno D, Di Salvo ME, Cincotta G, et al. Usefulness of the SYNTAX score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease. Circulation Cardiovasc Interv. 2009;2:302–308
  4. Capodanno D, Capranzano P, Di Salvo ME, et al. Usefulness of SYNTAX score to select patients with left main coronary artery disease to be treated with coronary artery bypass graft. J Am Coll Cardiol Intv. 2009;2:731–738
  5. Birim O, van Gameren M, Bogers AJ, et al. Complexity of coronary vasculature predicts outcome of surgery for left main disease. Ann Thorac Surg. 2009;87:1097–1104
  6. Ranucci M, Castelvecchio S, Menicanti L, et al. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation. 2009;119:3053–3061
  7. Capodanno D, Miano M, Cincotta G, et al. EuroSCORE refines the predictive ability of SYNTAX score in patients undergoing left main percutaneous coronary intervention. Am Heart J. 2009;159:103–109

PII: S0002-8703(10)00156-0

doi:10.1016/j.ahj.2010.02.014

Refers to article:

  • SYNTAX score and left main stenting: Do we need clinical variables to predict outcomes?

    Iñigo Lozano, Pablo Avanzas, Juan Rondan
    American Heart Journal May 2010 (Vol. 159, Issue 5, Page e25)

American Heart Journal
Volume 159, Issue 5 , Page e27, May 2010

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