Changing of SYNTAX score performing fractional flow reserve in multivessel coronary artery disease

Abstract

In patients with multivessel CAD, implementation of SYNTAX score with FFR seems to be a more rational approach for revascularization. F-SYNTAX score reclassifies a significant proportion of patients to a lower-risk profile, thus leading to a possible change of therapeutic strategy.

Impact on Prognosis of Periprocedural Myocardial Infarction after Percutaneous Coronary Intervention

“…Only a limited portion of these patients has been shown to develop lesions detectable by late‐gadolinium enhancement at magnetic resonance imaging, though with a still unknown impact on prognosis. Moreover, more data should be reported about patients presenting with multivessel coronary artery disease, with particular coronary anatomy while, recently, a fractional flow reserve (FFR)‐based PCI has demonstrated to reduce PMI …”

“…Moreover, more data should be reported about patients presenting with multivessel coronary artery disease, 29 with particular coronary anatomy 30,31 while, recently, a fractional flow reserve (FFR)-based PCI has demonstrated to reduce PMI. 32,33 Controversial results have emerged primarily from studies using troponin (I or T) as the marker of choice, while with CK-MB has generally shown a greater agreement toward a prognostic value of periprocedural myocardial infarction, even if consistent results were shown only for markedly elevated levels. 23,25,34 The majority of the studies showing an unfavorable outcome with elevations in CK-MB included a high percentage of patients with ACS, and many post-procedural increases in CK-MB were actually pre-procedural.…”

RAPSTROM™ First‐in‐Man Study Long‐Term Results of a Biodegradable Polymer Sustained‐Release Sirolimus‐Eluting Stent in De Novo Coronary Stenoses

“…Drug‐eluting stents (DES) have markedly reduced the rate of in‐stent restenosis compared with bare metal stents (BMS), resulting in a significant reduction in repeat revascularizations, also for patients with severe coronary artery disease and with technological advances . Their efficacy relies on the ideal combination of key components including metallic scaffold, drug carrier, and antiproliferative agent, which are critical to achieving adequate drug delivery and release at the target site . Moreover, strut thickness and cell design might also contribute to DES efficacy, since strut thickness in BMS has previously been reported to significantly reduce neointimal hyperplasia (NIH) as compared to platforms with thicker struts .…”

Bridging the Atlantic gap in clinical guidelines for non-ST-elevation acute coronary syndromes

“…Indeed, despite the established fact that on average only half of angiographically significant coronary stenoses cause ischemia, myocardial ischemia is not chosen as the key decisional criterion. 7 As malpractice and financial issues are substantial, unless expedited invasive management is chosen, an imaging test is indeed useful already before admission to decide whether to actually admit the patient or discharge him/her after temporary observation, as well as to minimize the risk of sudden death or MI after discharge. For this purpose, a CT scan and/or a cadmium-zinctelluride/CT camera should be available to all centers given the limited dimensions and ease of exam.…”

“…4,7 For instance, CT-derived anatomic imaging, which provides for instance details on lesion location, plaque features, vessel remodeling, calcium score, and stenosis severity can be seamlessly combined with MPI-derived functional imaging, which yields several functional parameters provided by MPI, including, most recently, coronary flow reserve. 6,[13][14][15] Thus, hybrid imaging provides many important results which are complementarily associated with pre-test and stress features, enabling the best clustering of the patient into a low-risk group, or otherwise prompting expedited invasive assessment, or guiding postdischarge management and follow-up.…”