Table 4.
Contemporary Risk Scores for Decision Making or Risk Prediction for Left Main or Multivessel Coronary Artery Disease
| SYNTAX Score I | SYNTAX Score II | SYNTAX Score II 2020 | EuroSCORE | STS Score | ACEF Score | |
|---|---|---|---|---|---|---|
| Year of publication | 2005 | 2013 | 2020 | 1999: EuroSCORE I (additive) 2003: EuroSCORE I (logistic) 2012: EuroSCORE II |
2007 2018: entirely new risk model |
2009 |
| Clinical use | Angiographic tool for objectively grading the complexity of CAD and guiding decision making between CABG and PCI | To guide the optimum revascularization method in patients with complex CAD. | For predicting 10-y deaths and 5-y MACEs after CABG or PCI | The prediction of early mortality in cardiac surgical patients | Predicting the postoperative mortality in patients undergoing open heart surgery | Assessing operative mortality risk in elective cardiac operations |
| Development data set | Initially established itself as an anatomic-based tool to force the heart team to analyze the coronary angiogram and agree that equivalent revascularization (CABG and PCI) could be achieved | CABG and PCI cohorts of the SYNTAX trial (N = 1,800) | SYNTAXES (SYNTAX Extended Survival) study (N = 1,800) | EuroSCORE I: development data set (N = 13,302)/validation data set (N = 1,479) EuroSCORE II: development data set (N = 16,828)/validation data set (N = 5,553) |
Development data set: July 2011 to June 2014 STS Adult Cardiac Surgery Database data (isolated CABG [N = 439,092], isolated valve surgery [N = 150,150], combined procedure [N = 81,588]) Validation data set: July 2014 to December 2016 STS Adult Cardiac Surgery Database |
Development data set: 4,557 patients having surgery in the San Donato Hospital from 2001 to 2003 Validation data set: 4,091 patients having surgery in the same hospital from 2004 to 2007 |
| External validation set of initial publication | Not applicable | DELTA registry (N = 2,891) | 10-y death: only internally validated 5-y all-cause death and 5-y MACEs: externally validated by use of data from the FREEDOM, BEST, and PRECOMBAT trial cohort (N = 3,380) | Not applicable | Not applicable | Not applicable |
| Study population | Patients with complex CAD (3-vessel or LMCA disease) undergoing PCI or CABG | Same as SYNTAX score I | Same as SYNTAX score I | Cardiac surgical patients in Europe | Patients undergoing cardiac surgery | Patients undergoing an elective cardiac operation |
| Outcomes of interest | MACCEs (death, stroke, MI, and repeat revascularization) | 4-y mortality | All-cause death at 10 years 5-y all-cause death 5-y MACEs |
Postoperative mortality (death within 30 d of operation or within the same hospital admission) | Mortality and postoperative complications (a composite of morbidity and 30-d mortality, length of stay, neurologic injury, deep sternal wound infection, prolonged ventilation, renal failure, and reoperation) | Operative mortality (in-hospital mortality or mortality by 30 d after the operation for patients discharged from the hospital) |
| Calculator | http://www.syntaxscore.org/calculator/syntaxscore/frameset.htm | http://www.syntaxscore.org/calculator/syntaxscore/framesetss2.htm | https://syntaxscore2020.com/ | EuroSCORE I: http://www.euroscore.org/calcold.html EuroSCORE II: http://www.euroscore.org/calc.html (EuroSCORE II) |
https://riskcalc.sts.org/stswebriskcalc/calculate (periodically recalibrated) | Not applicable |
ACEF = Age, Creatinine, and Ejection Fraction; BEST = Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease; CAD = coronary artery disease; DELTA = Drug- Eluting Stent for Left Main Coronary Artery Disease; EuroSCORE = European System for Cardiac Operative Risk Evaluation; FREEDOM = Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease; MACE = major adverse cardiovascular event; other abbreviations as in Table 1, Table 2, and Table 3.