Functional Complete Revascularization as Determined by an Optimized Scoring System After Revascularization: A Post...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging & Diagnostics

Background:

• Complete revascularization (CR) after percutaneous coronary intervention (PCI) improves patient outcomes.
• The classic residual functional SYNTAX score (c-rFSS) assesses CR but has limitations.
• Optimizing CR assessment is crucial for reducing major adverse cardiac events (MACE).

Purpose of the Study:

• To optimize the c-rFSS algorithm into a novel modified rFSS (m-rFSS).
• To evaluate the prognostic implications of m-rFSS in patients undergoing PCI.
• To assess the association of m-rFSS-determined CR with 2-year MACE.

Main Methods:

• Development of the m-rFSS algorithm, accounting for suboptimal results and functionally significant stenoses missed by c-rFSS.
• Analysis of 1,555 patients with data for both c-rFSS and m-rFSS.
• Comparison of 2-year MACE rates between patients with CR and incomplete revascularization (IR) based on m-rFSS.

Main Results:

• The m-rFSS reclassified 12.0% of patients from CR to IR.
• m-rFSS identified a higher proportion of patients with incomplete revascularization (33.7%) compared to c-rFSS (21.7%).
• Patients with m-rFSS-defined IR had a significantly higher risk of MACE (20.8% vs 5.9%; aHR 3.32).
• m-rFSS demonstrated superior predictive accuracy for 2-year MACE compared to c-rFSS (C-index difference 0.07, p < 0.001).

Conclusions:

• The novel m-rFSS algorithm enhances the assessment of functional complete revascularization after PCI.
• m-rFSS provides more accurate prognostication of 2-year MACE than c-rFSS.
• Improved assessment of revascularization completeness using m-rFSS is strongly associated with better patient prognosis.