- SYNTAX score should not be used to guide coronary revascularization choice in patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD).
Why this matters
- Diabetes is associated with complex CAD and increased cardiovascular morbidity/mortality.
- Trial randomly assigned 1900 patients with diabetes and multivessel CAD to percutaneous coronary intervention (PCI) with drug-eluting stents or coronary artery bypass grafting (CABG).
- Hard cardiovascular events (HCE) endpoint was composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke.
- Major adverse cardiac and cerebrovascular events (MACCE) were composite of HCE and repeat revascularization.
- Funding: NIH.
- In the PCI group, significant difference in MACCE (P=.04) and nonsignificant difference for HCE (P=.07) between SYNTAX categories.
- SYNTAX score independently predicted HCE at 5 years in PCI group (HR per SYNTAX unit: 1.03; P=.002).
- In CABG group, no difference in cardiovascular events between SYNTAX categories at 5-year follow-up.
- Higher MACCE incidence in PCI patients with low, intermediate, and high SYNTAX scores compared with CABG group (36.6% vs 25.9% with low SYNTAX category [P=.02]; 43.9% vs 26.8% with intermediate SYNTAX [P<.001 vs with high syntax>
- Not powered for comparisons between SYNTAX subgroups overall or individual MACCE components.