Abstract
ObjectiveTo evaluate the predictive accuracy of SYNTAX score (SS) I and II for detecting significant carotid artery stenosis (CAS) in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting (CABG) surgery.MethodsThe study population consisted of 416 patients. Clinical, demographic, and radiological records were retrospectively reviewed. Characteristics of patients with CAS (n=66) and patients without CAS (n=350) were compared before and after propensity score matching analysis.ResultsPatients with significant CAS were older compared to those without significant CAS [(60 (53-65) vs. 63 (59-67); P=0.01]. However, atherosclerotic risk factors and SS I were similar between groups. SS II CABG and percutaneous coronary intervention (PCI) were significantly higher in patients with CAS [37.4 (30.9-43.5) vs. 33.8 (29.9-38.9); P=0.02]. After propensity score matching analysis (66 vs. 66), age, SS II PCI and CABG were significantly higher in patients with CAS than those without CAS [37.4 (30.9-43.5) vs. 33 (29.3-36.9); P=0.03]. Age, SS II PCI and CABG were associated with CAS in logistic regression analysis [OR=1.086, 95% CI (1.032-1.143), P<0.001; OR=1.054, 95% CI (1.010-1.101), P=0.02; OR=1.078, 95% CI (1.029-1.129), P<0.01].In ROC curve analysis, SS II PCI >33.1 had 68.2% sensitivity and 54.6% specificity [AUC=0.624, P=0.01, 95% CI (0.536-0.707)] whereas SS II CABG >26.1 had 81.8% sensitivity and 54.6% specificity [AUC=0.670, P<0.01, 95% CI (0.583-0.749)] to predict CAS. Pairwise comparison of ROC curves revealed similar statistical accuracy for prediction of CAS (z statistic: 0.683, P=0.49)ConclusionSS II is useful to predict asymptomatic CAS in patients with multivessel coronary artery disease.
Highlights
Multivessel coronary artery disease is often accompanied by involvement of carotid and lower extremity arteries[1]
SYNTAX score (SS) II PCI and coronary bypass grafting (CABG) were associated with carotid artery stenosis (CAS) in logistic regression analysis [OR=1.086, 95% CI (1.032-1.143), P
In Receiver-operating characteristic (ROC) curve analysis, SS II PCI >33.1 had 68.2% sensitivity and 54.6% specificity [AUC=0.624, P=0.01, 95% CI (0.536-0.707)] whereas SS II CABG >26.1 had 81.8% sensitivity and 54.6% specificity [AUC=0.670, P
Summary
Multivessel coronary artery disease is often accompanied by involvement of carotid and lower extremity arteries[1]. Association between coronary artery disease and carotid artery stenosis (CAS) is well documented in previous studies[2]. Coexisting CAS in patients with multivessel coronary artery disease undergoing coronary bypass grafting (CABG) cause worse outcomes[3]. Prediction of CAS in patients undergoing CABG may improve outcomes[4]. SYNTAX score (SS) I and II are recent scores which are used for choosing the treatment modality in patients with multivessel disease. Several studies showed a close association between these scores and cardiovascular
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