Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II

Influence of Diabetes Mellitus on Long-Term Outcomes of Patients With Unprotected Left Main Coronary Artery Disease Treated With Either Drug-Eluting Stents or Coronary Artery Bypass Grafting

“…26,27) Farooq, et al developed SYNTAX score II which contains 8 predictors, including the presence of ULMCA disease, and could well predict 4-year mortality in patients with complex coronary artery disease. 8) Diabetes was excluded from the SYN-TAX score II since diabetes was not an independent predictor of mortality in patients with complex coronary artery disease. Therefore, they demonstrated the presence of diabetes was not important for decision making between CABG and PCI in patients with complex coronary artery disease (P interaction = 0.67).…”

“…[3][4][5] Therefore, much attention has been paid to identifying appropriate risk stratification to help determine the optimal revascularization strategy in patients with ULMCA disease. [6][7][8] Among many risk factors, diabetes was a strong independent predictor of adverse outcome in patients with coronary artery disease. [9][10][11] Previous studies have shown CABG performed better than PCI in diabetic patients with multivessel disease, [12][13][14] indicating that diabetes might be an important consideration when selecting a revascularization strategy in patients with severe coronary artery disease.…”

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

“…These stable patients typically have symptoms of chest pain suspected to be angina and/or abnormal stress testing, in the setting of no obstructive CAD at coronary angiography 1, 2. The definition of obstructive CAD varies between different guidelines or studies 3, 4, 5, 6, 7, 8, 9, 10. In general, “normal”‐appearing coronary arteries are defined as 0% luminal stenosis or <20%, and non–obstructive CAD (NOCAD) is defined as luminal stenosis >20% but <50% 3, 8, 9, 10.…”

“…In general, “normal”‐appearing coronary arteries are defined as 0% luminal stenosis or <20%, and non–obstructive CAD (NOCAD) is defined as luminal stenosis >20% but <50% 3, 8, 9, 10. However, some studies use a threshold of <70% for NOCAD,4 while anatomical scores consider a stenosis ≥50% as significant 5, 6, 11. Traditional understanding of obstructive CAD was 70%12; however, recent European Society of Cardiology and American College of Cardiology/American Heart Association (ACC/AHA) guidelines shifted to include stenosis of 50% to 70% if there is associated inducible ischemia or fractional flow reserve ≤0.08 when considering the physiological significance of stenosis and revascularization management in patients with stable CAD 6, 7…”

Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

“…35 Newer scoring methods for PCI that add clinical variables to angiographic characteristics, like the "clinical SYNTAX score" and the "SYNTAX II score," have shown better accuracy than the angiographic SYNTAX score used in this study in predicting adverse events. 36,37 Unfortunately, unlike the angiographic SYNTAX score, these newer scores have not been tested in a study on CABG patients and have not made it into routine clinical practice. In our study it was not entirely clear for all patients how decisions were made to undergo one method of revascularization versus the other.…”