Modifying angiographic syntax score according to PCI strategy: lessons learnt from ERACI IV Study

Area of Science:

• Interventional Cardiology
• Coronary Artery Disease Management
• Vascular Imaging and Assessment

Background:

• The SYNTAX score (SS) stratifies risk after percutaneous coronary interventions (PCI) with drug-eluting stents.
• Current guidelines recommend CABG for intermediate to high SS, while PCI is an option for low SS.
• The original SS includes lesions with ≥50% stenosis in vessels ≥1.5 mm.

Purpose of the Study:

• To evaluate the impact of a modified SS calculation based on ERACI IV registry criteria.
• To assess if a conservative PCI strategy, focusing on severe lesions in larger vessels, impacts risk assessment.
• To align SS scoring with the goal of complete functional revascularization.

Main Methods:

• Recalculated SS based on ERACI IV registry criteria: treating lesions ≥70% stenosis in vessels ≥2.0 mm reference diameter.
• Excluded intermediate lesions (50-69% stenosis) and severe stenosis in smaller vessels (<2.0 mm).
• Analyzed the impact of this modified scoring on overall SS and its correlation with study outcomes.

Main Results:

• Modified SS calculation significantly reduced the overall SS compared to the original scoring.
• Exclusion of intermediate lesions and lesions in smaller vessels aligned with the ERACI IV study's complete revascularization strategy.
• This approach correlated with low one-year adverse events in the ERACI IV registry.

Conclusions:

• Recalculating SS to include only severe stenosis (≥70%) in vessels with a reference diameter ≥2.0 mm allows for a more rational assessment of coronary anatomy.
• This refined scoring supports a more conservative PCI strategy.
• The findings suggest that a tailored approach to SS scoring can optimize treatment decisions and improve patient outcomes.