From the Guidelines
The SYNTAX score cutoff for determining the suitability of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) is ≤22 for low-risk patients, 23-32 for intermediate-risk patients, and ≥33 for high-risk patients, as supported by the 2024 ESC guidelines for the management of chronic coronary syndromes 1.
Key Considerations
- The SYNTAX score is a critical tool in assessing the complexity of coronary artery disease, with higher scores indicating more complex disease.
- Patients with SYNTAX scores ≤22 have outcomes as favorable as after CABG, making PCI a suitable option for this group.
- For patients with SYNTAX scores ≥33, CABG is typically preferred due to the higher complexity of their coronary anatomy, as evidenced by higher mortality rates with PCI in this subgroup 1.
Clinical Implications
- The choice between PCI and CABG should be guided by the SYNTAX score, among other clinical factors, to optimize patient outcomes.
- A heart team approach is recommended for patients with intermediate SYNTAX scores (23-32) to individualize treatment decisions.
- Recent studies, such as the SYNTAXES trial, underscore the importance of considering the SYNTAX score in revascularization decisions to minimize adverse outcomes like mortality and repeat revascularization 1.
From the Research
Syntax Score Cutoff
The syntax score cutoff is a critical value used to determine the complexity of coronary artery disease (CAD) and predict clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
- A syntax score cutoff of ≥33 is considered relevant in determining worse clinical outcomes following PCI 2, 3, 4.
- This cutoff value is used to stratify patients into high-risk groups, with higher scores indicating more complex CAD and a greater risk of adverse outcomes.
- Other studies have used different cutoff values, such as ≤22,23-32, and ≥33, to predict long-term incidences of major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing PCI for 3-vessel disease 4.
- A syntax score of 29.5 has been identified as the optimal cutoff to predict MACCE with a sensitivity of 82.4% and specificity of 65.6% 4.
Clinical Outcomes
The syntax score cutoff is associated with clinical outcomes, including:
- Mortality: higher syntax scores are associated with increased mortality rates 2, 3, 4, 5.
- MACCE: higher syntax scores are associated with increased rates of MACCE, including repeat revascularization, acute coronary syndrome, and stroke 2, 3, 4, 5.
- Repeated revascularization: higher syntax scores are associated with increased rates of repeated revascularization 2.