The Impact of SYNTAX Score on Long term All-Cause Mortality and Late MACCE of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention for Left Main Coronary Artery Disease: A Systematic Review and Meta Analysis of Cohort Studies

Abstract

Background: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the best revascularization methods for patients with left main coronary artery disease (LMCAD). The SYNTAX score has been recommended for selecting revascularization methods. However, CABG is the standard for complex lesions measured by SYNTAX score at baseline.

Methods: This systematic review and meta-analysis used all studies on the different impacts of SYNTAX score with long-term all-cause mortality and late MACCE on patients with PCI and CABG for LMCAD. This search yielded 1,675 studies, of which 4 studies were included for the final analysis. In these studies, 4,490 patients were treated with PCI and CABG.

Results: A total of four studies were included and analyzed. The results shown that, there was a significantly higher difference in the long term all-cause mortality with high SYNTAX score of PCI compared to CABG (HR: 1.44; 95% CI: 1.16-1.79; p=0.0010) and not significant in low to intermediate SYNTAX (HR:0.94; 95% CI: 0.73-1.21, p=0.63). The pooled analysis showed that there was no significant difference in long term late MACCE in high and low to intermediate SYNTAX score (HR: 1.37; 95% CI: 0.94-1.98; p=0.10 and HR: 1.04; 95% CI: 0.85-1.28; p=0.69, respectively).

Conclusion: Among LMCAD patients, CABG is associated with a lower risk of causing long-term all-cause mortality than PCI with a high SYNTAX score. Meanwhile, the outcomes of MACCE in any SYNTAX score are not significantly different between CABG and PCI.