Utility of the SYNTAX score in predicting outcomes after coronary intervention for chronic total occlusion

Abstract

The SYNTAX score is predictive of procedural failure, as is the J-CTO score. Furthermore, a higher SYNTAX score is strongly associated with an increased risk of 30-day MACE. The SYNTAX score is useful for clinical decision making when treating patients with complex CTO lesions.

Predictive scores in chronic total occlusions percutaneous recanalization: only fashionable or really useful?

“…CTO lesions were then graded as easy, intermediate, difficult, and very difficult (J-CTO scores of 0, 1, 2, and ≥3 respectively). Since then, the J-CTO score has been found to predict the overall likelihood of CTO PCI success (10,17); however, other reports demonstrated low calibration and discrimination of J-CTO score in predicting technical success of CTO percutaneous attempts (15,18). Similarly to Christopoulos et al 17, we have shown that the higher the J-CTO score, the greater the use of antegrade dissection reentry techniques and retrograde approaches.…”

“…Nagashima et al reported lower procedural success of CTO PCI in patients with a high SYNTAX (>22) score than those with a low SYNTAX score (74.7% vs. 91.8%, respectively; P<0.0001) (10). Moreover, a SYNTAX score >22 was also an independent predictor of 30-day major adverse cardiac events (odds ratio =4.80, 95% CI: 1.03-22.42) (10). Nonetheless, the use of SYNTAX score is more appropriate for diseased patent coronary arteries than CTOs, particularly when PCI is indicated.…”

“…The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is an angiographic tool that can quantify the degree of atherosclerosis in the entire coronary arterial tree, including the culprit lesions and is useful to select appropriate candidates for coronary artery bypass graft (CABG) surgery or PCI with drug-eluting stents in patients with left main and/or three-vessel disease (9). Nagashima et al reported lower procedural success of CTO PCI in patients with a high SYNTAX (>22) score than those with a low SYNTAX score (74.7% vs. 91.8%, respectively; P<0.0001) (10). Moreover, a SYNTAX score >22 was also an independent predictor of 30-day major adverse cardiac events (odds ratio =4.80, 95% CI: 1.03-22.42) (10).…”

Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention – a step by step practical approach and an observational study

“…[ 10 ] Several studies have also emphasized the importance of the SYNTAX score in predicting the success of CTO PCI at different locations of CTO. [ 11 , 12 ] Some studies have also reported that a higher SYNTAX score is correlated with the increased difficulty of ostial CTO PCI. [ 12 ]…”

High Stakes: CTO-PCI in the Post-CABG Patient

“…Indeed, according to a quick count, no less than 5 clinical scores have been evaluated in CTOs to various extents, including patients with previous coronary artery bypass graft (CABG). [9][10][11][12][13][14][15][16][17][18][19] In addition to scores on the basis of regional registries (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom [RECHARGE] in Europe, 20 Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS-CTO] in the United States, 14,15 and Japanese Chronic Total Occlusion [J-CTO] score in Japan 9,10,21 ), these include scores more familiar to the non-CTO operator (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery [SYNTAX] Score 11 ) as well as scores that rely on advanced imaging techniques (Computed Tomography Registry of Chronic Total Occlusion Revascularization [CT-RECTOR] 12,18 ). Overall, however, these scores have tended to perform modestly in external validation studies, assessed using the area under the receiver operating curve method (approximately 0.6-0.7 depending on the study and outcome of interest).…”