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Respiratio 2018; 8 (1-2):83-92




Bojan M. Stanetić¹, Miodrag C. Ostojić², Tamara Kovacević-Preradović³, Ioannis Tentzeris4, Miklos Rohla4, Kurt Huber4


¹ Klinika za kardiologiju Univerzitetskog kliničkog centra Republike Srpske, Banja Luka, Republika Srpska, Bosna i Hercegovina                                                                                                                                                                           

² Univerzitet u Beogradu, Medicinski fakultet, Beograd, Srbija

³ Univerzitet u Banjoj Luci, Medicinski fakultet, Banja Luka, Republika Srpska, Bosna i Hercegovina

4Wiener Krankenanstaltenverbund, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria


Original research

Naučni članak

doi: 10.26601/rsp.aprs.18.11


Abstract: Introduction: The SYNTAX Score II (SSII) aims to assist the Heart Team by providing estimated all-cause mortality predictions at 4 years after percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. This score was externally validated in three large multicenter registries as well as in a pooled analysis of two randomized trials. However, in order to achieve general applicability, every score needs to be validated many times including patient population from different regions. The objective of the present study was to evaluate the predictive performance of SSII in patients with complex coronary artery disease (CAD) in a real-world multicenter population undergoing CABG from Austria and Bosnia and Herzegovina.


Methods: We included 414 consecutive patients (172 from Wilhelminenspital, Vienna, Austria and 242 from University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina) with angiographically (≥50% diameter stenosis) proven significant unprotected left main coronary artery (ULMCA) disease and/or three-vessel CAD who were referred for CABG between January 1, 2008, and December 31, 2010. All-cause mortality at 4 years was ascertained in 96.1% of patients. The SSII was calculated for each patient using an electronic calculator available on the website


Results:The mean age of the included patients was 64.7±9.3 years, 315/414 (76.1%) were men, 352/414 (85.0%) had arterial hypertension, 165/414 (39.9%) were diabetic and 271/414 (65.5%) were smokers. A significant UMLCA disease was found in 188/414 (45.4%) patients, 69.3% (287/414) of patients had three-vessel CAD, whereas 14.7% (61/414) had both three-vessel CAD and significant ULMCA disease. All-cause mortality at 4-year follow-up was 10.8%. The SSII showed moderate performance in discriminating between low- and high-risk patients (c-index=0.74 [95% CI 0.70 to 0.77]). Except in the patient cohort with the highest risk (where the SSII overestimated the risk in both institutions), the SSII indicated a good agreement between the actual and predicted 4-year total mortality.


Conclusion: The present study showed strong predictive performance and moderate discriminatory abilities of the SSII in a “real-world” complex CAD population undergoing CABG.


Keywords: SYNTAX Score II; Complex Coronary Artery Disease; Coronary Artery Bypass Grafting


Full Article (PDF)


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