Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 8;12(18):5844.
doi: 10.3390/jcm12185844.

Functional (Re)Development of SYNTAX Score II 2020: Predictive Performance and Risk Assessment

Antonella Scala  1 , Andrea Erriquez  1 , Filippo Maria Verardi  1 , Andrea Marrone  1 , Ennio Scollo  1 , Michele Trichilo  1 , Alessandro Durante  2 , Delio Tedeschi  3 , Bernardo Cortese  4 , Alfonso Ielasi  5 , Giuliano Valentini  6 , Matteo Tebaldi  1 , Gianluca Campo  1 , Rita Pavasini  1 , Simone Biscaglia  1
Affiliations

Functional (Re)Development of SYNTAX Score II 2020: Predictive Performance and Risk Assessment

Antonella Scala et al. J Clin Med. .

Abstract

The present study investigates the prognostic value of the Syntax Score II 2020 corrected for flow-limiting lesions and its ability to better address treatment by benefit prediction among patients with left main or multivessel disease. We analyzed 1274 patients from the HALE-BOPP cohort and integrated the Syntax Score II 2020 with the result of the fractional flow reserve (FFR) evaluation. Absolute risk difference (ARD) between surgical and percutaneous revascularization was calculated for anatomic and functional Syntax Score II 2020 predicted mortality. The ARD allowed to stratify the population into two large categories: "coronary artery bypass graft (CABG) better" with ARD ≥ 4.5% and "CABG-percutaneous coronary intervention (PCI) equipoise" with ARD < 4.5%. The mean global anatomical Syntax Score was 15.5 ± 9.2, whereas the functional one was 9.5 ± 10 (p < 0.01). Using the anatomic Syntax Score II 2020, 881 patients had a CABG-PCI equipoise. This number increased to 1041 after considering only flow-limiting lesions by FFR (p < 0.001); therefore, 40% of CABG better patients were reclassified within the CABG-PCI equipoise category. Kaplan-Maier curves showed similar actual survival rates for patients originally with CABG-PCI equipoise and those reclassified, in both cases higher than those from CABG better patients (p < 0.01). The integration between Syntax Score II 2020 and physiology is feasible, and merging clinical, anatomic and functional data allows for better risk prediction and therapeutic guidance.

Keywords: fractional flow reserve; multivessel disease; syntax score.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Reclassification through functional Syntax Score II 2020. One hundred sixty (40%) patients with ARD ≥ 4.5%, defined by Syntax Score II 2020, are reclassified in the “CABG-PCI equipoise” group with ARD < 4.5%. SS-II 2020: Syntax score-II-2020; ARD: absolute risk difference; CABG: coronary artery bypass graft; PCI: percutaneous coronary intervention.
Figure 2
Figure 2
Sankey diagram showing “CABG better” patients’ reclassification into “CABG-PCI equipoise” group. CABG: coronary artery bypass graft. PCI: percutaneous coronary intervention.
Figure 3
Figure 3
Kaplan–Meier survival estimates stratifying the study cohort based on the ARD cut-off of 4.5%. Patients with ARD ≥ 4.5%, with most comorbidities and risk factors, had the worst survival estimates, as expected. ARD: absolute risk difference.
Figure 4
Figure 4
Kaplan–Meier survival estimates stratifying the study cohort based on the revascularization strategy suggested by ARD. “CABG-PCI equipoise” group is composed of patients originally with ARD < 4.5% assessed by Syntax Score II 2020. “CABG better” group is composed of patients originally with ARD ≥ 4.5%. “Reclassified” group is composed of patients reclassified using the functional Syntax Score II 2020. SS-II 2020: Syntax Score II 2020. PCI: percutaneous coronary intervention. CABG: coronary artery bypass graft.
See this image and copyright information in PMC

References

    1. Neumann F.-J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U., Byrne R.A., Collet J.-P., Falk V., Head S.J., et al. 2018 ESC/EACTS Guidelines on Myocardial Revascularization. Eur. Heart J. 2019;40:87–165. doi: 10.1093/eurheartj/ehy394. - DOI - PubMed
    1. Hlatky M.A., Boothroyd D.B., Bravata D.M., Boersma E., Booth J., Brooks M.M., Carrié D., Clayton T.C., Danchin N., Flather M., et al. Coronary Artery Bypass Surgery Compared with Percutaneous Coronary Interventions for Multivessel Disease: A Collaborative Analysis of Individual Patient Data from Ten Randomised Trials. Lancet. 2009;373:1190–1197. doi: 10.1016/S0140-6736(09)60552-3. - DOI - PubMed
    1. Farkouh M.E., Domanski M., Sleeper L.A., Siami F.S., Dangas G., Mack M., Fuster V. Strategies for Multivessel Revascularization in Patients with Diabetes. N. Engl. J. Med. 2012;367:2375–2384. doi: 10.1056/NEJMoa1211585. - DOI - PubMed
    1. Park S.-J., Ahn J.-M., Kim Y.-H., Park D.-W., Yun S.-C., Lee J.-Y., Kang S.-J., Lee S.-W., Lee C.W., Park S.-W., et al. Trial of Everolimus-Eluting Stents or Bypass Surgery for Coronary Disease. N. Engl. J. Med. 2015;372:1204–1212. doi: 10.1056/NEJMoa1415447. - DOI - PubMed
    1. Fearon W.F., Zimmermann F.M., de Bruyne B., Piroth Z., van Straten A.H.M., Szekely L., Davidavičius G., Kalinauskas G., Mansour S., Kharbanda R., et al. Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery. N. Engl. J. Med. 2022;386:128–137. doi: 10.1056/NEJMoa2112299. - DOI - PubMed

LinkOut - more resources