Impact of the SYNTAX scores I and II in patients with diabetes and multivessel coronary disease: a pooled analysis of patient level data from the SYNTAX, PRECOMBAT, and BEST trials.
Aims
To assess the impact of the SYNTAX scores I and II in outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for patients with diabetes and multivessel disease (MVD).


Methods and results
We performed a patient-level pooled analysis of three large randomized trials of patients with MVD. The impact of coronary anatomic complexity as measured by the SYNTAX score in the differences in outcomes following PCI and CABG was assessed at a median follow-up of 5 years. We also assessed the performance of the SYNTAX II score model in patients with and without diabetes. From the 3280 patients enrolled in the three trials, a total of 1068 (32.6%) had diabetes. The rate of the composite of death, myocardial infarction (MI), or stroke was similar in the PCI and CABG arms in patients with low-intermediate (≤32) SYNTAX scores (15.1% vs. 14.9%, respectively; P = 0.93) while it was significantly higher in the PCI arm in patients with high (≥33) SYNTAX scores (24.5% vs. 13.2%, respectively; P = 0.018). The SYNTAX score II showed good calibration and moderate discrimination ability in patients with diabetes (c-index = 0.68) as well as in those without (c-index = 0.67).


Conclusions
Differences in 5 years outcomes following PCI and CABG for patients with MVD and diabetes were influenced by anatomic complexity as measured by the SYNTAX score. The SYNTAX score II mortality prediction model showed similar performance regardless of the diabetes status.
['Cavalcante|Rafael|R|', 'Sotomi|Yohei|Y|', 'Mancone|Massimo|M|', 'Whan Lee|Cheol|C|', 'Ahn|Jung-Min|JM|', 'Onuma|Yoshinobu|Y|', 'Lemos|Pedro A|PA|', 'van Geuns|Robert-Jan|RJ|', 'Park|Seung-Jung|SJ|', 'Serruys|Patrick W|PW|']
D000368:Aged D001026:Coronary Artery Bypass D003324:Coronary Artery Disease D003924:Diabetes Mellitus, Type 2 D003925:Diabetic Angiopathies D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D062645:Percutaneous Coronary Intervention D011183:Postoperative Complications D029424:Pulmonary Disease, Chronic Obstructive D012720:Severity of Illness Index D020521:Stroke D016896:Treatment Outcome
Coronary disease Trials Diabetes mellitus Stents Surgery