Reproducibilidad del puntaje SYNTAX en la práctica clínica Reproducibility of the SYNTAX score in medical practice

MTSAC During the last years, several randomized and controlled studies have demonstrated that the use of drug-eluting stents (DES) produces a significant reduction in restenosis rate and need for new revascularization compared to conventional stents. Consequently, percutaneous coronary interventions (PCI) with implant of DES in patients with multivessel disease (MVD) and complex coronary lesions have become more common. (1) According to current guidelines coronary artery bypass graft surgery (CABGS) is still the treatment of choice for patients with extensive coronary artery disease, including left main coronary artery (LMCA) disease and MVD. (2) The introduction of DES, together with the advances in adjuvant therapy during and after the procedure, has improved the outcome of PCI, so at present it represents a valid option instead of CABGS in this group of patients. (3) However, the international guidelines still recommend PCI in LMCA disease only for patients with high surgical risk or in emergencies, such as bailout procedures or acute myocardial infarction therapy, as recent studies have not demonstrated that PCI is superior or, at least, not inferior to CABGS in terms of need for new revascularization. (2) Several indices have been developed to stratify high-risk patients with LMCA disease or MVD. The SYNTAX score (SS) (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score) was postulated as a method for evaluating the complexity of coronary artery anatomy. (4) In the SYNTAX trial, the score has demonstrated a good discriminating prognostic ability for selecting patients eligible for CABGS or PCI. In addition, its reproducibility has indicated an acceptable level of accordance. (4, 5) In the present issue of the Argentine Journal of Cardiology, Lamelas et al. (6) have analyzed the reproducibility and degree of agreement of the score between highly trained interventional cardiologists and residents in cardiology, representative of intraining physicians in clinical cardiology. The goal of the study was to evaluate whether residents in clinical cardiology could make an adequate evaluation of the SS and to detect possible biases in this evaluation. Data from consecutive diagnostic coronary angiographies performed over a two year period in patients with left main coronary artery disease and/or three-vessel disease were retrospectively collected. None of the patients had history of previous revascularization. A resident in clinical cardiology (RC) in the second year of the residency program completed the tutorial and self evaluation available at the website www.syntaxscore. com.before starting to use the SS calculator. (7) The resident then calculated the total SS of the included angiographies by using the automated scoring algorithm available at the same website. These results were then compared with those calculated by an interventional cardiologist (IC) from the institution. The level of inter-observer agreement was evaluated using Cohen’s kappa coefficient based on previously accepted agreement values (0.41-0.60 moderate, 0.61-0.80 good and 0.80- 0.99 optimal). The results were also analyzed and presented in graphs with the classic Bland-Altman plot method. The results showed a good agreement between