SYNTAX score may predict the severity of atherosclerosis of the ascending aorta

SYNTAX score was first introduced as an angiographic tool to objectively quantify the complexity of coronary artery disease (CAD) (1). SYNTAX score has since become an integral part of the decision-making process in patients undergoing intervention for three-vessel or left main CAD. In fact, in the latest US and European guidelines for myocardial revascularization, recommendations for the treatment strategies for these patients with complex coronary disease—either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)—are based on the SYNTAX score (2,3). SYNTAX score has been identified as an independent predictor of mortality and major adverse cardiac or cerebrovascular events during follow-up especially in patients who undergo PCI (4,5). In patients who undergo CABG, the role of SYNTAX score as a prognostic indicator is not certain (4) and often times the score is considered irrelevant once surgery is indicated. However, it may be reasonable to assume that the complexity and degree of CAD represented by SYNTAX score is the surrogate of systemic atherosclerosis (6,7). This study was therefore designed to investigate the association of SYNTAX score with the severity of atherosclerosis mainly focusing on the ascending aorta, the most surgically relevant location in CABG