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The accuracy of subjective SYNTAX score category assessment and its influence on appropriateness of coronary revascularization in patients with stable coronary artery diseases

Session Poster session 1

Speaker Shen Lin

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : S Lin (Beijing,CN), Z Zheng (Beijing,CN), C Rao (Beijing,CN), B Xu (Beijing,CN), H Yan (Beijing,CN), Y Wu (Beijing,CN), K Dou (Beijing,CN), Y Tang (Beijing,CN), F Wu (Beijing,CN), C Guan (Beijing,CN)

Authors:
S. Lin1 , Z. Zheng1 , C. Rao1 , B. Xu1 , H. Yan1 , Y. Wu1 , K. Dou1 , Y. Tang1 , F. Wu1 , C. Guan1 , 1Fu Wai Hospital - Beijing - China People's Republic of ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 194-195

Background: The SYNTAX score (SS) has been recommended by clinical guideline and appropriate use criteria for coronary revascularization to provide guidance on optimal treatment strategies for patients with stable coronary artery diseases (CAD). However, discrepancy in SS between angiographic core lab (ACL) and cardiologists has been found. The accuracy of SS category assessment and its influence on treatment strategies in patients with stable CAD remain unknown. We therefore assessed the daily SS judgement and its impact on treatment.

Purpose: We sought to 1) evaluate the accuracy of subjective SS category judgement and influenced factors and to 2) discuss its impact on appropriateness of revascularization strategies in patients with stable CAD.

Methods: From August 2016 to December 2016, patients with stable CAD from one Chinese cardiac center undergoing elective coronary angiographies with at least one coronary lesion stenosis ≥50% were continuously recruited. Cardiologists were asked subjective SS category assessment (low, intermediate and high-risk) rightafter the coronary angiographies. All angiograms were reviewed by ACL to analysis the accuracy of cardiologists' judgement. Cardiologists and lesions level data were used to determine risk factors of misjudgement. The appropriateness of treatment was adjudicated by Chinese version appropriate use criteria for coronary revascularization. Hierarchical logistic regression was used to analyze the risk factors of misjudgement.

Results: We consecutively recruited 916 patients. The mean SS was 11.2±0.7. The total accuracy rate was 79.8% with the underestimate rate of 3.2% and the overestimate rate of 17.0%. The accuracy rates varied significantly from 63.8% to 100% among cardiologists. The accuracy rates in subjective low-risk, intermediate-risk and high-risk group were 96.8%, 33.1% (5%, underestimated; 61.9%, overestimated) and 37.4%, respectively. In lesions level, compared with SS low-risk lesions, misjudgement increased in intermediate-risk lesions (OR=2.81 [1.16–6.81]). Compared with 1 and 2-vessel lesions, misjudgement increased in 3-vessel (OR=2.55, [1.31–4.97]) and left main lesions (OR=4.82 [1.90–12.2]). In cardiologists (n=15) level, no relationship were found according to annual operation volumes (p>0.05). no relationship was found according to annual operation volumes (Table). 296 (32.3%) patients' treatment strategies were classified as appropriate. The appropriate rate was 25.4% in inaccurate judgement group and 34.9% in accurate group (p=0.014).

Conclusion: The accuracy rate of SS category assessment was low in our center, especially for SS intermediate-risk and complex lesions, regardless of cardiologists' experience. Inaccurate SS judgement was significantly associated with inappropriate treatment strategies for patients with stable coronary artery diseases. Measurements to improve cardiologists' SS assessment may be beneficial to revascularization appropriateness.

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