IMPACT OF SYNTAX SCORE ON THE EARLY OUTCOME OF CABG SURGERY IN LOW EJECTION FRACTION PATIENTS

Abstract

Despite tremendous medical progress over the last 20 years in the fields of conservative, interventional and surgical treatment, the selection of therapy in stable coronary artery disease (CAD) remains a challenge, Specifically, the optimal revascularization. (Hahalis and Alexopoulos., 2014). Coronary artery bypass graft surgery (CABG) has been considered the optimum revascularization treatment for patients with de novo left main (LM) disease and/or three-vessel disease (3VD) (Kappetein et al., 2011). Prior to the development of the SS, several coronary angiographic-based scores were created to risk-stratify patients with CAD. Most of these early scores were elaborated around the concept of quantification of myocardium at risk and/or severity of coronary artery stenosis.(Yadavet al., 2013) The awareness of the risk of feasible complications before treatment may lower these complications. The SYNTAX score (SS) is a scoring system to indicate the complexity of coronary artery disease (CAD), to select the optimal technique of revascularization and to distinguish patients at risk for major adverse events. Recently, the reproducibility of angiographic SSs has been shown to be clinically acceptable. Angiographic SSs are based on lesions and include parameters such as dominancy, number, location and length of the lesion, vessel tortuosity, grade of calcification, presence of thrombus and branching. The total SS is obtained by multiplying the score for each separate lesion. (Stahli et al., 2012) In real-life patients undergoing CABG, the Syntax score does not independently predict short-term outcome. Intermediate and high Syntax scores do identify high risk patients with increased crude mortality rates (Gannotet al., 2014) The SYNTAX score can not predict the outcome of CABG patients. SYNTAX suffers from lack of clinical risk factors. (Serruyset al., 2009) This study aims to clarify whether SYNTAX score affects the outcome of bypass grafting in CABG patients with low ejection fraction as defined by major adverse cerebrovascular and cardiac events (MACCE) and its components over 30 days postoperative follow-up period. Methods: 100 patients who underwent primary CABG for left main coronary artery disease or one, two, three vessel disease were studied all diagnostic angiograms were scored by one experienced investigator who was blinded as to procedural data and clinical outcome. Data were collected, revised, coded and entered to the Statistical Package for Social Science (IBM SPSS) version 20. Qualitative data were presented as number and percentages while quantitative data with parametric distribution were presented as mean, standard deviations and ranges. The comparison between two groups with qualitative data were done by using Chi-square test and/or Fisher exact test was used instead of Chi-square test when the expected count in any cell was found less than 5. Comparison between two independent groups regarding quantitative data with parametric distribution were done by using Independent t-test. Comparison between more than two independent groups regarding quantitative data with parametric distribution were done by using One Way ANOVA. Spearman correlation coefficients were used to assess the correlation between syntax score and the studied parameters. The confidence interval was set to 95% and the margin of error accepted was set to 5%. So, the p-value was considered significant as the following: • P > 0.05: Non significant • P < 0.05: Significant • P < 0.01: Highly significant.