Real-world study to compare functional SYNTAX score versus anatomical SYNTAX score in influencing the treatment strategy for multivessel disease patients

There are limited prospective clinical studies that use the functional SYNTAX score (FSS) to determine treatment strategies, as compared to the anatomical SYNTAX score (ASS), in patients with multivessel disease (MVD). We sought to compare the change in treatment strategy and healthcare cost benefits between ASS and FSS in patients with chronic stable angina and/or recent acute coronary syndrome with MVD. This was a prospective, multicenter, multi-country, open-label study that enrolled 577 patients from 16 sites across Thailand, India, and Hong Kong. After angiographic assessment, the first treatment strategy was decided based on ASS information. Thereafter, the second treatment strategy was decided based on FSS. Subsequently, the physicians were asked to document the actual treatment received by the patient. The primary endpoint was a proportional change in treatment strategy based on FSS evaluated using κ-statistics and the Bowker-McNemar test. A total of 577 patients with 1833 lesions were assessed. The overall mean ASS was 17.0 ± 8.5, and the mean FSS score was 11.2 ± 9.6. FSS reclassified 28.1% of patients from the high-risk group toward the low-risk group. FSS reclassified more than one-third of patients with ASS > 22 to FSS ≤ 22. FSS-based decision making led to a statistically significant change (p < 0.0001) in treatment strategy for 53% of the patients. This change reduced the procedure-related cost by 10%. The overall major adverse cardiovascular events rate at 1-year follow-up was 4.5%. In the real-world setting, FSS significantly influenced the determination of appropriate treatment options among MVD patients and led to a reduction in procedure-related costs.