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BACKGROUND: Heart Team (HT) and the SYNTAX Score II (SSII) have been integrated to the contemporary guidelines with the aim to provide a multidisciplinary decision-making process between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). AIMS: To prospectively assess the agreement between the HT decision and the SSII recommendation regarding the revascularization strategy in patients with 3-vessel coronary artery disease (CAD) of the SYNTAX II trial. METHODS: The SSII predicts the 4-year mortality of an individual patient both after PCI and after CABG. Patients were treated by PCI when the SSII predicted a mortality risk favoring PCI or when risk predictions were equipoise between PCI and CABG. However, the HT could overrule the SSII and recommend either CABG or PCI. RESULTS: A total of 202 patients have been screened and 24 did not fulfill inclusion criteria. The median age was 67.0 (IQR 59.0-73.3), and 167 (82.7%) were male. The HT endorsed SSII treatment recommendation, for CABG or PCI, in 152 patients (85.4%). Three patients had preference for PCI, irrespective of the HT decision. The main reason for the HT to overrule the SSII and recommend CABG was the prospect of a more complete revascularization (21 of 25 patients). Patients recommended for CABG by the HT had significantly higher anatomical SYNTAX score (P = 0.03) and higher predicted mortality risk for PCI (P = 0.04) when compared with patients that were enrolled in the trial. CONCLUSION: The SYNTAX score II showed to be a suitable tool for guiding treatment decisions of patients with 3-vessel coronary artery disease being endorsed by the HT in the vast majority of the patients that have been enrolled in the SYNTAX II trial.

Original publication

DOI

10.1002/ccd.25907

Type

Journal article

Journal

Catheter Cardiovasc Interv

Publication Date

15/11/2015

Volume

86

Pages

E229 - E238

Keywords

coronary artery disease, drug eluting, risk stratification, stent, Adult, Aged, Angioplasty, Balloon, Coronary, Coronary Angiography, Coronary Artery Bypass, Coronary Artery Disease, Coronary Restenosis, Decision Making, Decision Making, Computer-Assisted, Drug-Eluting Stents, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Care Team, Patient Selection, Predictive Value of Tests, Prospective Studies, Risk Assessment, Severity of Illness Index, Single-Blind Method, Survival Rate, Time Factors, Treatment Outcome