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Functional (Re)Development of SYNTAX Score II 2020: Predictive Performance and Risk Assessment
Antonella Scala1, Andrea Erriquez1, Filippo Maria Verardi1
1Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy.
Journal of Clinical Medicine
|September 28, 2023
Summary
Integrating fractional flow reserve (FFR) with Syntax Score II 2020 improves risk prediction for patients with left main or multivessel coronary artery disease, guiding better treatment decisions between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- Left main or multivessel coronary artery disease requires careful treatment selection between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
- The Syntax Score II 2020 provides an anatomical assessment for risk stratification, but its prognostic accuracy can be enhanced.
- Fractional flow reserve (FFR) assesses the functional significance of coronary lesions, offering complementary information to anatomical scores.
Purpose of the Study:
- To evaluate the prognostic value of the Syntax Score II 2020 when corrected for flow-limiting lesions identified by FFR.
- To determine if integrating FFR improves the prediction of treatment benefit (CABG vs. PCI) in patients with left main or multivessel disease.
- To assess the impact of FFR-guided revascularization decisions on patient outcomes.
Main Methods:
- Analysis of 1274 patients from the HALE-BOPP cohort.
- Integration of the Syntax Score II 2020 with FFR results to calculate functional Syntax Score II 2020.
- Calculation of Absolute Risk Difference (ARD) to stratify patients into 'CABG better' (ARD ≥ 4.5%) and 'CABG-PCI equipoise' (ARD < 4.5%) categories.
- Comparison of survival rates using Kaplan-Meier curves.
Main Results:
- The mean anatomical Syntax Score II 2020 was 15.5 ± 9.2, while the functional score was 9.5 ± 10 (p < 0.01).
- Using anatomical Syntax Score II 2020 alone, 881 patients were in the CABG-PCI equipoise category.
- Incorporating FFR reclassified 40% of 'CABG better' patients into the equipoise category, increasing the equipoise group to 1041 patients (p < 0.001).
- Reclassified equipoise patients showed similar survival rates to the originally equipoise group, both higher than the 'CABG better' group (p < 0.01).
Conclusions:
- The integration of Syntax Score II 2020 with FFR is feasible and clinically applicable.
- Merging clinical, anatomical (Syntax Score II 2020), and functional (FFR) data improves risk prediction accuracy.
- This integrated approach provides better guidance for therapeutic decisions in patients with left main or multivessel coronary artery disease.
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