The Clinical Syntax Score is a better survival predictive method compared to the Syntax Score in Coronary Revascularization - Insights from a Prospective National Registry in Israel

SYNTAX score (SS) is a useful tool for customizing revascularization treatment for patients with multi-vessel coronary disease. In the last decade, the clinical SS (CSS) has emerged as a more comprehensive tool. The current study set out to compare the survival predictive values of the SS versus CSS and their future application in real-world implementation of the revascularization guidelines.

This study was a sub-analysis of data collected in a prospective national registry in Israel that enrolled consecutive survival of patients with left main and/or 2- to 3-vessel CAD involving the proximal or mid-left anterior descending artery; the MULTICAD (MULTI-vessel Coronary Artery Disease). Patients were categorized by their SS, CSS and their revascularization method (PCI Vs. CABG).

A total of 585 patients were included in the study with a 5-year follow-up. The median CSS was 27, with 288 patients showing a CSS >27, with a mean CSS of 47.85 and a mean SS of 29.05. At 3- and 5-years post-treatment, the CSS>27 group had a lower survival probability, CSS>27 was associated with a lower survival probability among patients undergoing PCI as compared to those undergoing CABG. More specifically, the high-CSS CABG group had a 5-year mortality rate of 16.8%, while the high-CSS PCI group had a 5-year mortality rate of 32.2%. When comparing SS to CSS for the 5-year mortality outcome prediction, CSS was found superior to SS with a higher AUC.

This prospective registry of real-world revascularization strategies in patients with multi-vessel, demonstrated that CSS is a better predictive tool of post-revascularization survival than SS. Moreover, it demonstrated that surgical revascularization in patients with CSS>27 is associated with better an all-cause mortality outcome post CABG as comparison to post PCI. This attests to the need of use of a score that considers clinical parameters in real-world guideline implementation.