Comparative Analysis of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in Left Main Disease Stratification by Angiographic SYNTAX Score

Using the SYNTAX score (SS) for decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for left main coronary artery (LMCA) revascularization is under scrutiny. This study investigated the clinical outcomes of LMCA revascularization stratified by SS. This multicenter study included 2138 patients recruited between 2015 and 2020 who underwent LMCA disease revascularization using PCI or CABG and were categorized based on their SS into three groups: low (≤22), intermediate (23-32), and high (≥33). Patients with a high SS compared with those with an intermediate SS experienced increased hospital mortality (Odds ratio: 1.99; P = .026) and Major Adverse Cardiac and Cerebrovascular Event (MACCE; OR: 2.17; P = .006). With an average follow-up of 24.7 months, no substantial differences emerged in MACCE (Hazard ratio: 1.23; P = .52) or mortality (HR: 3.26; P = .073] between patients with high and intermediate SSs. A significant interaction between the SS category (low vs intermediate) and LMCA revascularization modality was observed for hospital MACCEs, favoring PCI over CABG (OR: 0.32; P = .033). However, no noteworthy interactions between SS categories and revascularization modalities were noted concerning hospital or follow-up mortality or follow-up MACCEs. These findings raise doubts about the utility of SS alone in selecting left-main revascularization modalities for LMCA disease.Keywords: CABG; MACCE; PCI; SYNTAX score; left-main coronary artery disease; mortality.