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Introduction Coronary atherosclerotic burden and SYNTAX score (SS) are
predictors of cardiovascular events. Objectives To investigate the
value of SYNTAX scores (SS, SSII and residual SS [rSS]) for predicting
cardiovascular events in patients with coronary artery disease (CAD).
Design Retrospective cohort study. Setting Single tertiary centre.
Participants Medicine, Angioplasty or Surgery Study (MASS) database
patients with stable multivessel CAD and preserved ejection fraction.
Interventions CAD patients undergoing coronary artery bypass graft (CABG),
percutaneous coronary intervention (PCI), or medical treatment (MT) alone
from January 2002 to December 2015. Primary and secondary outcomes
Primary: 5-year all-cause mortality. Secondary: composite of all-cause
death, myocardial infarction, stroke, and subsequent coronary
revascularization at 5 years. Results A total of 1,719 patients
underwent PCI (n = 573), CABG (n = 572), or MT (n = 574) alone. The SS was
not considered an independent predictor of 5-year mortality in the PCI
(low, intermediate and high SS 6.5%, 6.8% and 4.3%, respectively,
p=0.745), CABG (low, intermediate and high SS 5.7%, 8.0% and 12.1%,
respectively, p=0.194) and MT (low, intermediate and high SS 6.8%, 6.9%
and 6.5%, respectively, p=0.993) cohorts. The SSII (low, intermediate and
high SSII, 3.6% vs. 7.9% vs. 10.5%, respectively, p <0.001) was
associated with a higher mortality risk in the overall population. Within
each treatment strategy, SSII was associated with a significant 5-year
mortality rate, especially in CABG patients with higher SSII (low,
intermediate and high SSII, 1.8%, 9.7% and 10.0%, respectively, p = 0.004)
and in MT patients with high SSII (low, intermediate and high SSII, 5.0%,
4.7% and 10.8%, respectively, p = 0.031). SSII demonstrated a better
predictive accuracy for mortality compared with SS and rSS
(c-index = 0.62). Conclusions Coronary atherosclerotic burden alone
was not associated with significantly increased risk of all-cause
mortality. The SSII better discriminates the risk of death.
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