Is the SYNTAX Score a Predictor of Long-term Outcome after Coronary Artery Bypass Surgery?


  • David M. Holzhey
  • Martin M. Luduena
  • Ardawan Rastan
  • Stephan Jacobs
  • Thomas Walther
  • Friedrich W. Mohr
  • Volkmar Falk



Background: The SYNTAX score was introduced to measure the complexity of coronary artery disease. Although a high SYNTAX score is indicative of a worse long-term outcome after percutaneous coronary intervention (PCI), it remains unclear whether it is also true for coronary artery bypass grafting (CABG).

Methods: We analyzed 200 consecutive CABG patients who underwent operations in 2002. Demographic and intraoperative data, perioperative outcomes, and 5-year outcomes were obtained. The SYNTAX score was calculated retrospectively by reviewing the original diagnostic angiograms. After excluding patients who had undergone CABG or PCI treatment within 6 months before surgery, we included 154 patients in the study. Patients were partitioned into tertiles according to the SYNTAX score (low, ?18; intermediate, >18-26; high, >26). Cox regression analysis was used to identify baseline and procedural predictors for the combined end point of 5-year major adverse cardiac and cerebrovascular events (MACCE) and its components. Cumulative event rates were estimated by Kaplan-Meier methods.

Results: The mean (±SD) age was 66.6 ± 8.5 years, the mean ejection fraction was 56.4% ± 13.6%, and the mean logistic EuroSCORE was 4.2% ± 4.7%. The SYNTAX score ranged between 2 and 52. The overall survival rate was 94.8% at 1 year and 84.1% at 5 years. The rate of freedom from MACCE was 92.9% and 78.0% at 1 and 5 years, respectively. Only a higher EuroSCORE, a New York Heart Association class of III to IV, and smoking could be identified with Cox regression as risk factors for MACCE during follow-up. The overall survival and MACCE rates of the 3 SYNTAX score subgroups were not significantly different.

Conclusions: Complex coronary pathology as measured by the SYNTAX score did not affect the long-term outcome after CABG in this study.


Birim O, van Gameren M, Bogers AJ, Serruys PW, Mohr FW, Kappetein AP. 2009. Complexity of coronary vasculature predicts outcome of surgery for left main disease. Ann Thorac Surg 87:1097-105.nBrener SJ, Galla JM, Bryant R 3rd, Sabik JF 3rd, Ellis SG. 2008. Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients. Am J Cardiol 101:169-72.nBriguori C, Condorelli G, Airoldi F, et al. 2007. Comparison of coronary drug-eluting stents versus coronary artery bypass grafting in patients with diabetes mellitus. Am J Cardiol 99:779-84.nBrodie BR, Stuckey T, Downey W, et al. 2008. Outcomes and complications with off-label use of drug-eluting stents: results from the STENT (Strategic Transcatheter Evaluation of New Therapies) group. JACC Cardiovasc Interv 1:405-14.nHannan EL, Wu C, Walford G, et al. 2008. Drug-eluting stents vs. coronary- artery bypass grafting in multivessel coronary disease. N Engl J Med 358:331-41.nJavaid A, Steinberg DH, Buch AN, et al. 2007. Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease. Circulation 116:I200-6.nKappetein AP, Dawkins KD, Mohr FW, et al. 2006. Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase. Eur J Cardiothorac Surg 29:486-91.nKo DT, Chiu M, Guo H, et al. 2009. Safety and effectiveness of drug-eluting and bare-metal stents for patients with off- and on-label indications. J Am Coll Cardiol 53:1773-82.nLemesle G, Bonello L, de Labriolle A, et al. 2009. Prognostic value of the Syntax score in patients undergoing coronary artery bypass grafting for three-vessel coronary artery disease. Catheter Cardiovasc Interv 73:612-67.nSerruys PW, Morice MC, Kappetein AP, et al. 2009. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 360:961-72.nStettler C, Wandel S, Allemann S, et al. 2007. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network metaanalysis. Lancet 370:937-48.nValgimigli M, Serruys PW, Tsuchida K, et al. 2007. Cyphering the complexity of coronary artery disease using the Syntax score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention. Am J Cardiol 99:1072-81.nvan Gaal WJ, Ponnuthurai FA, Selvanayagam J, et al. 2009. The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention. Int J Cardiol 135:60-5.n



How to Cite

Holzhey, D. M., Luduena, M. M., Rastan, A., Jacobs, S., Walther, T., Mohr, F. W., & Falk, V. (2010). Is the SYNTAX Score a Predictor of Long-term Outcome after Coronary Artery Bypass Surgery?. The Heart Surgery Forum, 13(3), E143-E148.