[From complex multivessel disease to cardiovascular health]

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Context:

• Drug-eluting stents (DES) offered hope for percutaneous coronary intervention (PCI) in complex coronary artery disease (CAD).
• Recent SYNTAX trial data indicates bypass surgery (CABG) shows lower restenosis and major cardiovascular events than DES.
• The SYNTAX score quantifies CAD complexity based on lesion anatomy.

Purpose:

• To evaluate the role of anatomical complexity (SYNTAX score) in guiding treatment decisions for multivessel and left main coronary artery disease.
• To synthesize evidence on integrating anatomical and functional parameters for risk stratification and treatment selection in CAD.
• To highlight the importance of high-resolution imaging in assessing individual risk profiles and treatment efficacy.

Summary:

• The SYNTAX score correlates lesion complexity with treatment outcomes, suggesting CABG benefits increase with higher scores.
• Studies like PROSPECT and FAME emphasize using imaging for acute coronary syndrome natural history and vulnerable plaque identification.
• Optimal management requires considering both anatomical (SYNTAX score) and functional parameters, supported by advanced imaging.

Impact:

• Findings support tailoring revascularization strategies based on individual patient anatomy and lesion complexity.
• High-resolution imaging is crucial for accurate risk profiling and predicting treatment benefits in complex CAD.
• Future research, like the FREEDOM study in diabetic patients, will further refine management strategies for high-risk populations.