The role of SYNTAX score in decision‐making for preoperative carotid artery screening in patients undergoing coronary artery bypass surgery

Abstract

Background The coexistence of coronary artery disease (CAD) in patients undergoing coronary artery bypass surgery (CABG) is a risk factor for stroke and death. The aim of this study is to evaluate the potential of the SYNTAX score (SXscore) for predicting carotid stenosis in patients undergoing CABG. Methods We retrospectively reviewed 291 patients (225 males, mean age 60.5 ± 8.5 years) who underwent CABG in a single center in 2014 and were screened for carotid artery preoperatively. The total SXscore was obtained by scoring every luminal narrowing greater than 50% in coronary vessels larger than 1.5 mm using the SXscore algorithm. Correlations between the severity of carotid stenosis and SXscore were analyzed. Results As the degree of carotid artery stenosis increases (≤%50; ≥%50 vs ≥%70), the mean SXscore (19.06 ± 7.72, P > 0,05; 28.40 ± 6.89, P < 0,01; 31.02 ± 7.04, P < 0.01, respectively) were found to increase. Receiver operating characteristic analysis revealed a cut‐off point of 27 or more in SXscore according to the presence of carotid stenosis greater than or equal to %70. The risk of existence of significant carotid stenosis was 58‐fold greater in cases with SXscore greater than or equal to 27. In cases with SXscore greater than or equal to 27, the risk of existence of significant carotid stenosis was 58‐fold greater with a confidence interval of 95%. Moreover, the presence of left main CAD was associated with the severity of carotid stenosis (<50% carotid stenosis, P > 0.05; ≥%50, P = 0.001; and ≥70, P = 0.001). Conclusion This study suggests that the presence of left main coronary artery disease or SXscore greater than or equal to 27 should require preoperative carotid screening in patients undergoing CABG, regardless of the presence of risk factors.

Concomitant severe carotid and coronary artery diseases: a separate management or concomitant approach

“…Recently, the role of SYNTAX score and left ventricular ejection fraction has been evaluated to carefully screen and select patients to undergo carotid screening and potential CEA as either staged or simultaneous procedure. The study by Akansel et al of 291 patients that underwent CABG and were screened for carotid artery disease noted that patients with left main coronary artery disease or SYNTAX score of 27 or more warrants preoperative screening for carotid artery disease as there is a high chance of coexistence of coronary and carotid artery diseases. The model from Akansel et al needs further expansion into clinical practice, and this could serve as the foundation of detecting more asymptomatic but significant carotid artery diseases that could potentially reduce mortality and stroke rates in such cohort.…”

Carotid artery stenosis in asymptomatic patients undergoing coronary artery bypass grafting: who and when should be screened?

“…reported a specificity of 90.4%, a sensitivity of 85.9%, and a SYNTAX score cut-off value of 27; moreover, that a SYNTAX score of ≥ 70% can be used as a predictor for CAS [19].…”