Preoperative SYNTAX score to assess the late outcomes after coronary endarterectomy for the diffusely diseased left anterior descending artery†

Abstract

To evaluate whether the preoperative Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score was associated with late outcomes of coronary endarterectomy (CE) for the diffusely diseased left anterior descending artery (LAD). We retrospectively analysed 205 of 212 patients undergoing CE for the diffusely diseased LAD between September 2004 and May 2016, excluding 2 patients without preoperative angiographic data and 5 redo cases. The mean SYNTAX score was 34.6. Patients were divided into 3 groups according to their SYNTAX score: low (≤22, n = 26), intermediate (23-32, n = 58) and high (≥33, n = 121). The study end-points were cardiac death and major adverse cardiac and cerebrovascular events, defined as all-cause death, cerebrovascular accidents, non-fatal myocardial infarction and repeat revascularization. All CEs involved long arteriotomy and the reconstruction of the endarterectomized LAD using the skeletonized internal thoracic artery. Postoperative mortality and morbidity were similar between the groups. The median follow-up period was 5.4 years. We found no significant difference in the cumulative cardiac death-free survival rate at 5 years (91.1% vs 100% vs 98.3%; log-rank, P = 0.196) or major adverse cardiac and cerebrovascular events (61.6% vs 71.5% vs 76.7%; log-rank, P = 0.258) in the low, intermediate and high SYNTAX score groups, respectively. Univariate and multivariate Cox proportional hazard analyses revealed no significant association between the study end-points and individual components of the SYNTAX score for the LAD. The preoperative SYNTAX score and its individual components for the LAD were not associated with late outcomes following CE for the diffusely diseased LAD.