Reproducibility of Syntax Score: From Core Lab to Real World

Aims: Syntax score is a significant tool in the management of complex coronary artery disease (CAD). This score is based on visual assessment of coronary lesions via coronary angiograms. It has some limitations due to its visual assessment. Therefore, interobserver and intraobserver agreement should be tested. Methods: One hundred twenty-two coronary angiograms were examined, and 76 in whom critical lesions were detected in the coronary arteries were included the study. Coronary angiograms were assessed by 2 independent interventional cardiologists. After 8 weeks, the same interventional cardiologists reassessed coronary angiograms by randomly choosing 30 patients from the first analysis. Results: For numeric Syntax score value, both interobserver and intraobserver variability shows perfect agreement but interobserver variability shows high mean difference. Syntax score was analyzed in terms of tertiles (<= 22, >22 - <= 32, >32), it has moderate agreement for interobserver variability (weighted kappa value of 0.56) and substantial agreement for intraobserver variability (weighted kappa value of 0.69). Conclusion: The Syntax score reproducibility is within acceptable limits in real world clinical practice and it may become a significant tool in complex CAD management. (J Interven Cardiol 2011;24:302-306)