Prognostic Role of Functional SYNTAX Score Based on Quantitative Flow Ratio

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging Analysis

Background:

• The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) traditionally assesses coronary lesion complexity.
• Integrating physiological data with anatomical assessment is crucial for comprehensive risk stratification.

Purpose of the Study:

• To evaluate the predictive value of the quantitative flow ratio (QFR)-based functional SYNTAX score (FSSQFR) for adverse cardiovascular outcomes.
• To assess the impact of FSSQFR on patient risk stratification compared to the traditional SS.

Main Methods:

• An offline FSSQFR calculation was performed in 410 consecutive patients undergoing coronary angiography.
• Patients were stratified into low, intermediate, and high-risk groups based on FSSQFR tertiles.
• The primary endpoint was a composite of all-cause death, myocardial infarction, ischemia-driven revascularization, heart failure hospitalization, and life-threatening arrhythmias.

Main Results:

• FSSQFR reclassified the risk category for 11% of the study population.
• After a median follow-up of 30.2 months, 85 primary composite events occurred.
• Patients in the high-risk FSSQFR group had a significantly higher incidence of the primary composite outcome compared to the low-risk group (HR: 1.95, p=0.016).

Conclusions:

• The FSSQFR provides valuable prognostic information beyond anatomical assessment alone.
• High-risk stratification by FSSQFR is associated with a significantly increased rate of major adverse cardiovascular events.
• FSSQFR may improve risk stratification in patients with coronary artery disease undergoing angiography.