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Variabilidad Interobservador del Score SYNTAX en pacientes con diagnóstico de Enfermedad Arterial Coronaria Multivaso.

Adrian Naranjo Dominguez, Ronald Aroche Aportela, Myder Hernández Nava, Angel Obregón Santos, Lázaro Aldama

Resumen


Introducción: El estudio SYNTAX introdujo el score del mismo nombre con el objetivo de ayudar al Heart Team a decidir la vía óptima de revascularización en los pacientes con enfermedad arterial coronaria multivaso y del tronco de la coronaria izquierda, del mismo han sido señalados varias limitaciones dentro de ellas la reproducibilidad en la práctica clínica real. Objetivo: Determinar la variabilidad interobservador del score SYNTAX en pacientes con diagnóstico de Enfermedad Arterial coronaria multivaso o del TCI. Material y Método: Estudio observacional transversal analítico. El universo de estudio estuvo conformado por 85 pacientes diagnosticados de enfermedad arterial coronaria multivaso durante el año 2016 en el Cardiocentro CIMEQ. La muestra se seleccionó por muestreo aleatorio simple conformada por 30 pacientes. Intervinieron 3 cardiólogos intervencionistas los que reprodujeron el score Syntax de manera individual. Se usó el índice de Kappa de Fleiss para determinar la variabilidad interobservador de las siguientes variables: No. De lesiones, Calcificación severa, Longitud de lesión mayor de 20mm, Bifurcación/Trifurcación, Enfermedad difusa o de vasos pequeños, oclusiones totales y SYNTAX Score. Resultados: Se obtuvo un índice de Kappa de 0.69 para la puntuación global y de 0.82, 0.60 y 0.94 para las variables No. De lesiones, Bifurcación/Trifurcación y Oclusiones Totales respectivamente. Existió mayor variabilidad en el rango de puntuaciones intermedias.Conclusiones: El SYNTAX score presentó una buena reproductibilidad interobservador. Las variables de mayor dispersión fueron la presencia de calcificación severa, longitud de las lesiones mayor de 20 mm y la enfermedad de vasos pequeños o difusa.

Introduction: The SYNTAX study introduced the score of the same name in order to help the heart team to decide the way optimal revascularization in patients with complex coronary artery disease and left coronary trunk, just have been identified several limitations within them reproducibility in real clinical practice. Objective: to determine the interobserver variability of the SYNTAX score in patients diagnosed with compelx coronary artery disease multivaso or left coronary trunk. Methods: observational cross-analytical study. The study universe was made by 85 patients diagnosed of complex coronary artery disease for 2016 in the CIMEQ Hospital. The sample was selected by simple random sampling made 30 patients. Took part 3 interventional cardiologists which reproduced the SYNTAX score of individually. Was used Kappa Fleiss index to determine the interobserver variability of the following variables: number of lesions, severe calcification, length of injury over 20 mm, bifurcation / trifurcation, diffuse disease or small vessel, total occlusions and global SYNTAX score. Results: was obtained an Kappa index 0.69 for the overall score and 0.82, 0.60 and 0.94 for the variables number of lesions, bifurcation / trifurcation and total occlusions respectively. There as more variability in the range rating 23-32 points. Conclusions: the SYNTAX score presented a good interobserver reproducibility. Variables greater dispersion were the presence of severe calcification severe, length of lesions greater than 20 mm and diffuse disease or small vessel.


Palabras clave


SYNTAX Score, Revascularización, ICP, CABG

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Referencias


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